Healthcare Provider Details

I. General information

NPI: 1760208425
Provider Name (Legal Business Name): MR. PHILIP ETHAN MERCADANTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 LARCH ST FL 3
SCRANTON PA
18509-2802
US

IV. Provider business mailing address

13 KOZEL LN
SCOTT TOWNSHIP PA
18411-7745
US

V. Phone/Fax

Practice location:
  • Phone: 570-489-5561
  • Fax: 570-489-5563
Mailing address:
  • Phone: 570-909-5470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: