Provider Demographics
NPI:1487711800
Name:BLANCO MERCADO, ELISY ISABEL (LICSW)
Entity type:Individual
Prefix:MRS
First Name:ELISY
Middle Name:ISABEL
Last Name:BLANCO MERCADO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BULLOCKS POINT AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-5351
Mailing Address - Country:US
Mailing Address - Phone:401-952-1104
Mailing Address - Fax:
Practice Address - Street 1:24 SCHOOL STREET
Practice Address - Street 2:CHILD & FAMILY
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840
Practice Address - Country:US
Practice Address - Phone:401-849-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW008261041C0700X
RIISW019951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical