Healthcare Provider Details

I. General information

NPI: 1992665756
Provider Name (Legal Business Name): EDMARIE MERCADO PSICOLOGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIFICIO AOR BALDORIOTY NORTE 165 LOCAL 3
AIBONITO PR
00705-3031
US

IV. Provider business mailing address

URB.COLINAS DE SAN FRANCISCO H-90 CALLE NATALIA
AIBONITO PR
00705-3031
US

V. Phone/Fax

Practice location:
  • Phone: 939-255-8745
  • Fax:
Mailing address:
  • Phone: 939-255-8745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number8458
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: