Healthcare Provider Details

I. General information

NPI: 1871006718
Provider Name (Legal Business Name): KARISSA MERCADO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 FINCHVILLE TPKE
OTISVILLE NY
10963-3102
US

IV. Provider business mailing address

56 FINCHVILLE TPKE
OTISVILLE NY
10963-3102
US

V. Phone/Fax

Practice location:
  • Phone: 845-280-5373
  • Fax: 845-302-8609
Mailing address:
  • Phone: 845-280-5373
  • Fax: 845-302-8609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: