Healthcare Provider Details

I. General information

NPI: 1124316310
Provider Name (Legal Business Name): ANGEL LUIS MERCADO LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CALLE DOLORES LOLITA NATAL APT 805
MANATI PR
00674-9016
US

IV. Provider business mailing address

8 CALLE DOLORES LOLITA NATAL APT 805
MANATI PR
00674-9016
US

V. Phone/Fax

Practice location:
  • Phone: 787-974-2543
  • Fax:
Mailing address:
  • Phone: 787-974-2543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0244
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: