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General NPI Number Information
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NPI Number | 1568229938
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Entity Type | Individual
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Provider Name | CARISMA NATALIS MERCADO LAC
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Gender | Female
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 786 KING GEORGE RD
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City | FORDS
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State | NJ
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Zip | 08863-1981
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Country | US
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Telephone | 732-638-0443
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Fax |
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Provider Business Mailing Address
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Address Line | 215 PERSHING AVE APT 2
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City | CARTERET
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State | NJ
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Zip | 07008-3057
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Country | US
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Telephone | 646-764-5382
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 37AC00780500
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License Number State | NJ
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