Provider Demographics
NPI:1982493169
Name:DEMERCURIO, RABERTA JAMY
Entity type:Individual
Prefix:
First Name:RABERTA
Middle Name:JAMY
Last Name:DEMERCURIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 CLAYPOND RD UNIT H
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-7389
Mailing Address - Country:US
Mailing Address - Phone:843-286-9157
Mailing Address - Fax:
Practice Address - Street 1:3675 CLAYPOND RD UNIT H
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-7389
Practice Address - Country:US
Practice Address - Phone:843-286-9157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17733104100000X
NY126943-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker