Healthcare Provider Details

I. General information

NPI: 1255741849
Provider Name (Legal Business Name): SORRELL MERCOGLAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 A1A S SUITE B5
SAINT AUGUSTINE FL
32080-2916
US

IV. Provider business mailing address

6255 W SUNSET BLVD FL 21
LOS ANGELES CA
90028-7422
US

V. Phone/Fax

Practice location:
  • Phone: 518-257-2975
  • Fax:
Mailing address:
  • Phone: 323-860-5200
  • Fax: 323-467-7119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW10978
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: