Provider Demographics
NPI:1487226544
Name:MERCURIO, MELYSSA (PSYD, NCSP, MT-BC)
Entity type:Individual
Prefix:DR
First Name:MELYSSA
Middle Name:
Last Name:MERCURIO
Suffix:
Gender:F
Credentials:PSYD, NCSP, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-1812
Mailing Address - Country:US
Mailing Address - Phone:716-628-5686
Mailing Address - Fax:
Practice Address - Street 1:1350 OLD FREEPORT RD STE 1A
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3122
Practice Address - Country:US
Practice Address - Phone:412-406-7734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11899225A00000X
PAPS019326103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist