Provider Demographics
NPI:1396547139
Name:MERCEDES, GLORIBEL
Entity type:Individual
Prefix:
First Name:GLORIBEL
Middle Name:
Last Name:MERCEDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 STAFFORD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-1174
Mailing Address - Country:US
Mailing Address - Phone:508-762-2224
Mailing Address - Fax:
Practice Address - Street 1:205 STAFFORD ST APT 1
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-1174
Practice Address - Country:US
Practice Address - Phone:508-762-2224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS09984002172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver