MEDICARE: MARIAFE AINELLE MERCADO PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS02010	RI

General Provider Information

NPI Number	:	1760991699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAFE AINELLE MERCADO PSYD

Provider Business Mailing Address
First Line	:	1135 CHARLES ST
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-3538
Country	:	US
Telephone Number	:	401-400-7745
Fax Number	:	401-757-3229

Provider Business Practice Location Address
First Line	:	1135 CHARLES ST
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-3538
Country	:	US
Telephone Number	:	401-400-7745
Fax Number	:	401-757-3229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2017
Last Update Date	:	05/30/2025

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