Provider Demographics
NPI:1902666183
Name:ROBLEDO DIAZ, MERCIE (CPLP)
Entity type:Individual
Prefix:
First Name:MERCIE
Middle Name:
Last Name:ROBLEDO DIAZ
Suffix:
Gender:F
Credentials:CPLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SECTOR LOS PENAS 1183 CALLE DORADO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-5052
Mailing Address - Country:US
Mailing Address - Phone:787-404-7834
Mailing Address - Fax:
Practice Address - Street 1:SECTOR LOS PENAS 1183 CALLE DORADO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-5052
Practice Address - Country:US
Practice Address - Phone:787-404-7834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 175T00000X, 390200000X
PR1821101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No175T00000XOther Service ProvidersPeer Specialist
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)