Provider Demographics
NPI:1679556930
Name:MERCADO, JANYNA MARIE (PHD)
Entity type:Individual
Prefix:
First Name:JANYNA
Middle Name:MARIE
Last Name:MERCADO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19016 STONE OAK PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3281
Mailing Address - Country:US
Mailing Address - Phone:210-860-9622
Mailing Address - Fax:844-404-6016
Practice Address - Street 1:19016 STONE OAK PKWY STE 210
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3281
Practice Address - Country:US
Practice Address - Phone:210-860-9622
Practice Address - Fax:844-404-6016
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32917103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0035PBOtherBCBS TX
TX32917OtherPSYCHOLOGIST LICENSE
TX32917OtherPSYCHOLOGIST LICENSE
TX32917OtherPSYCHOLOGIST LICENSE