Provider Demographics
NPI:1528639895
Name:DE LA TORRE MERCADO, NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:DE LA TORRE MERCADO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 262
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0262
Mailing Address - Country:US
Mailing Address - Phone:787-458-9359
Mailing Address - Fax:
Practice Address - Street 1:90 CALLE ALONDRA, 65 INFANTERIA PLAZA65
Practice Address - Street 2:SHOPPING CENTER SUITE 30 SABANA LLANA NORTE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3254
Practice Address - Country:UM
Practice Address - Phone:787-377-2035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6991103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical