Provider Demographics
NPI:1063695310
Name:LORETTA L MERCER INC
Entity type:Organization
Organization Name:LORETTA L MERCER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:727-863-9486
Mailing Address - Street 1:13910 FIVAY RD
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7154
Mailing Address - Country:US
Mailing Address - Phone:727-863-9486
Mailing Address - Fax:727-846-0380
Practice Address - Street 1:13910 FIVAY RD
Practice Address - Street 2:SUITE ONE
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7154
Practice Address - Country:US
Practice Address - Phone:727-863-9486
Practice Address - Fax:727-846-0380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW0002244251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4155Medicare PIN