Healthcare Provider Details

I. General information

NPI: 1720933153
Provider Name (Legal Business Name): MERCEDES DERICHO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 PLAZA REAL STE 275
BOCA RATON FL
33432-3999
US

IV. Provider business mailing address

1313 W BOYNTON BEACH BLVD 1B 346
BOYNTON BEACH FL
33426-3436
US

V. Phone/Fax

Practice location:
  • Phone: 561-528-1423
  • Fax:
Mailing address:
  • Phone: 786-389-9773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26126
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: