Provider Demographics
NPI:1720825342
Name:MERCADO, FELIPE (PPSC, ASW, ADMIN)
Entity type:Individual
Prefix:DR
First Name:FELIPE
Middle Name:
Last Name:MERCADO
Suffix:
Gender:M
Credentials:PPSC, ASW, ADMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 E BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-5709
Mailing Address - Country:US
Mailing Address - Phone:559-759-2790
Mailing Address - Fax:
Practice Address - Street 1:6405 E BUTLER AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-5709
Practice Address - Country:US
Practice Address - Phone:559-759-2790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2201024951041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool