Healthcare Provider Details

I. General information

NPI: 1477436632
Provider Name (Legal Business Name): LYZZETTE MERCADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 5 BOX 34589
HATILLO PR
00659-9798
US

IV. Provider business mailing address

HC 5 BOX 34589
HATILLO PR
00659-9798
US

V. Phone/Fax

Practice location:
  • Phone: 787-409-9176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number7194
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: