Provider Demographics
NPI:1154187003
Name:MERCADANTE, ERIC DEVANEY (LMSW)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:DEVANEY
Last Name:MERCADANTE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831-1714
Mailing Address - Country:US
Mailing Address - Phone:518-469-1979
Mailing Address - Fax:
Practice Address - Street 1:6 CHELSEA PL STE 103
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3236
Practice Address - Country:US
Practice Address - Phone:844-253-4229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121459104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker