Healthcare Provider Details

I. General information

NPI: 1922365360
Provider Name (Legal Business Name): JOY MARY MERCER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 MAIN RD
CORFU NY
14036-9753
US

IV. Provider business mailing address

860 MAIN RD
CORFU NY
14036-9753
US

V. Phone/Fax

Practice location:
  • Phone: 585-599-6446
  • Fax: 585-599-3166
Mailing address:
  • Phone: 585-599-6446
  • Fax: 585-599-3166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18P83297
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: