Individual
MS. MARY J MERCURIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC, LCDP
Contact information
Practice address
75 SOCKANOSSET CROSS ROAD, SUITE 208, CRANSTON, RI 02920
(401) 398-1963
Mailing address
11 BLUEBERRY LANE, CRANSTON, RI 02921
(401) 943-0000
(401) 943-0314
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCDP 288
RI
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCDP00288
RI
101YM0800X
Mental Health Counselor
Primary
MHC 000287
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000031312
BLUE CROSS
RI
01
—
413292
BLUE CHIP
RI
05
—
MM58994
—
RI
Enumeration date
09/27/2006
Last updated
05/26/2011
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