Healthcare Provider Details

I. General information

NPI: 1689011819
Provider Name (Legal Business Name): VIVIAN ILEANA MERCADO MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 SPENCER ST
MANCHESTER CT
06040-4601
US

IV. Provider business mailing address

177 JERRY RD
EAST HARTFORD CT
06118-3125
US

V. Phone/Fax

Practice location:
  • Phone: 860-522-8241
  • Fax: 860-524-8143
Mailing address:
  • Phone: 860-522-8241
  • Fax: 860-524-8143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: