Provider Demographics
NPI:1730892605
Name:MERCADO, GLORIA MARIA (MSW)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:MARIA
Last Name:MERCADO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2066 BEARING LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5924
Mailing Address - Country:US
Mailing Address - Phone:939-881-4706
Mailing Address - Fax:
Practice Address - Street 1:2066 BEARING LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5924
Practice Address - Country:US
Practice Address - Phone:939-881-4706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR77871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical