Healthcare Provider Details

I. General information

NPI: 1386190213
Provider Name (Legal Business Name): MICHELLE MERCADO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 NW 17TH AVE
MIAMI FL
33125-1547
US

IV. Provider business mailing address

1951 NW 17TH AVE
MIAMI FL
33125-1547
US

V. Phone/Fax

Practice location:
  • Phone: 305-774-9570
  • Fax:
Mailing address:
  • Phone: 305-774-9570
  • Fax: 305-774-9573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: