Healthcare Provider Details

I. General information

NPI: 1922261874
Provider Name (Legal Business Name): LAUREN C MERCER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 WASHINGTON AVE SUITE 203
HAMDEN CT
06518-3271
US

IV. Provider business mailing address

60 WASHINGTON AVE SUITE 203
HAMDEN CT
06518-3271
US

V. Phone/Fax

Practice location:
  • Phone: 203-288-0414
  • Fax: 203-288-3655
Mailing address:
  • Phone: 203-288-0414
  • Fax: 203-288-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number52499
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number52499
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: