Provider Demographics
NPI:1932958709
Name:LCDA. KIMBERLIE LOPEZ MERCADO
Entity type:Organization
Organization Name:LCDA. KIMBERLIE LOPEZ MERCADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICA SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA
Authorized Official - Phone:787-616-7743
Mailing Address - Street 1:813 CALLE VEREDA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-3514
Mailing Address - Country:US
Mailing Address - Phone:787-616-7743
Mailing Address - Fax:
Practice Address - Street 1:CARR.511 KM 2.O
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-616-7743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty