MEDICARE: MARILYN JANISSE MERCADO GIUSTI PSY D

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	103T00000X	Psychologist	004571	PR

General Provider Information

NPI Number	:	1861837999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN JANISSE MERCADO GIUSTI PSY D

Provider Business Mailing Address
First Line	:	2712 VILLA DR NW
Second Line	:	APT B
City	:	CLEVELAND
State	:	TN
Zip	:	37312-1958
Country	:	US
Telephone Number	:	787-672-7127
Fax Number	:

Provider Business Practice Location Address
First Line	:	2712 VILLA DR NW
Second Line	:	APT B
City	:	CLEVELAND
State	:	TN
Zip	:	37312-1958
Country	:	US
Telephone Number	:	787-672-7127
Fax Number	:

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

Provider Enumeration Date	:	05/02/2013
Last Update Date	:	05/02/2013

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Directions to “ MARILYN JANISSE MERCADO GIUSTI PSY D” Practice Location

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