Healthcare Provider Details

I. General information

NPI: 1235426008
Provider Name (Legal Business Name): MS. PAULA V. MERCADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 CLEARVIEW AVE
WEST HARTFORD CT
06119-2202
US

IV. Provider business mailing address

31 CLEARVIEW AVE
WEST HARTFORD CT
06119-2202
US

V. Phone/Fax

Practice location:
  • Phone: 646-460-2859
  • Fax:
Mailing address:
  • Phone: 646-460-2859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: