MEDICARE: MERCEDES DERICHO

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	1041C0700X	Clinical Social Worker	SW26126	FL

General Provider Information

NPI Number	:	1720933153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERCEDES DERICHO

Provider Business Mailing Address
First Line	:	11 NOTTINGHAM PL
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8427
Country	:	US
Telephone Number	:	786-389-9773
Fax Number	:

Provider Business Practice Location Address
First Line	:	1313 W BOYNTON BEACH BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-3436
Country	:	US
Telephone Number	:	561-528-1423
Fax Number	:

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

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “ MERCEDES DERICHO ” Practice Location

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