Provider Demographics
NPI:1659197101
Name:MERCADO, LIONEL CRISTIAN
Entity type:Individual
Prefix:DR
First Name:LIONEL
Middle Name:CRISTIAN
Last Name:MERCADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3069 AVE EMILIO FAGOT
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4115
Mailing Address - Country:US
Mailing Address - Phone:787-981-5105
Mailing Address - Fax:
Practice Address - Street 1:3069 AVE EMILIO FAGOT
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4115
Practice Address - Country:US
Practice Address - Phone:787-981-5105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8199103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical