MEDICARE: MS. MERCEDES PATRICIA CISNEROS-WATSON MA, LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		IL

General Provider Information

NPI Number	:	1114982097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MERCEDES PATRICIA CISNEROS-WATSON MA, LCPC

Provider Business Mailing Address
First Line	:	4300 COMMERCE COURT SUITE 300-16
Second Line	:
City	:	LISLE
State	:	IL
Zip	:	60532-3698
Country	:	US
Telephone Number	:	630-505-0103
Fax Number	:	630-933-9474

Provider Business Practice Location Address
First Line	:	4300 COMMERCE CT
Second Line	:
City	:	LISLE
State	:	IL
Zip	:	60532-3698
Country	:	US
Telephone Number	:	630-505-0103
Fax Number	:	630-933-9474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	07/08/2007

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