Provider Demographics
NPI:1811631831
Name:MERCADO MUNOZ, ANGELIVETTE (MA)
Entity type:Individual
Prefix:
First Name:ANGELIVETTE
Middle Name:
Last Name:MERCADO MUNOZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB BUENAVENTURA
Mailing Address - Street 2:CALLE GARDENIA 4007
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-9998
Mailing Address - Country:US
Mailing Address - Phone:787-458-5448
Mailing Address - Fax:
Practice Address - Street 1:CARR 345 KM 2 H 1 EDIF CASA BLANCA
Practice Address - Street 2:LOCAL 7
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660-9998
Practice Address - Country:US
Practice Address - Phone:787-458-5448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6086103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist