MEDICARE: CARMEN ANA MERCADO MFT INTERN

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	106H00000X	Marriage & Family Therapist	132263	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932456316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN ANA MERCADO MFT INTERN

Provider Business Mailing Address
First Line	:	1409 COLBY AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2409
Country	:	US
Telephone Number	:	415-300-7987
Fax Number	:

Provider Business Practice Location Address
First Line	:	1409 COLBY AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2409
Country	:	US
Telephone Number	:	415-300-7987
Fax Number	:

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

Provider Enumeration Date	:	08/05/2012
Last Update Date	:	02/04/2025

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