Healthcare Provider Details

I. General information

NPI: 1831280544
Provider Name (Legal Business Name): MARY J MERCURIO LMHC, LCDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY J MERCURIO LMHC

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SOCKANOSSET CROSS ROAD SUITE 208
CRANSTON RI
02920
US

IV. Provider business mailing address

11 BLUEBERRY LN
CRANSTON RI
02921-1310
US

V. Phone/Fax

Practice location:
  • Phone: 401-398-1963
  • Fax:
Mailing address:
  • Phone: 401-398-1963
  • Fax: 401-386-2389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9688
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000287
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDP00288
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDP 288
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: