Provider Demographics
NPI:1679397145
Name:MERCADO, JENNIFER EFFIE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:EFFIE
Last Name:MERCADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13588 PROSPECTOR RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-8851
Mailing Address - Country:US
Mailing Address - Phone:760-662-4473
Mailing Address - Fax:
Practice Address - Street 1:13588 PROSPECTOR RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-8851
Practice Address - Country:US
Practice Address - Phone:760-662-4473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker