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General NPI Number Information
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NPI Number | 1063695310
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Entity Type | Organization
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Legal Business Name | LORETTA L MERCER INC
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 13910 FIVAY RD SUITE ONE
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City | HUDSON
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State | FL
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Zip | 34667-7154
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Country | US
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Telephone | 727-863-9486
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Fax | 727-846-0380
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Provider Business Mailing Address
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Address Line | 13910 FIVAY RD SUITE ONE
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City | HUDSON
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State | FL
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Zip | 34667-7154
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Country | US
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Telephone | 727-863-9486
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Fax | 727-846-0380
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MS. LORETTA L MERCER
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Credential | LCSW
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Telephone | 727-863-9486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | SW0002244
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License Number State | FL
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