Provider Demographics
NPI:1285451070
Name:VIERA MERCADO, ASTRID MARIE (MS)
Entity type:Individual
Prefix:MISS
First Name:ASTRID
Middle Name:MARIE
Last Name:VIERA MERCADO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7045 CALLEJON A ROMAN
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-9710
Mailing Address - Country:US
Mailing Address - Phone:939-366-6802
Mailing Address - Fax:
Practice Address - Street 1:42905 CARR 482
Practice Address - Street 2:BARRIO COCOS
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:939-366-6802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7098103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty