Provider Demographics
NPI:1235622473
Name:MERCURI, JOANNA M
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:MERCURI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLAKELY
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1362
Mailing Address - Country:US
Mailing Address - Phone:570-795-9015
Mailing Address - Fax:
Practice Address - Street 1:1714 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:PA
Practice Address - Zip Code:18447-1362
Practice Address - Country:US
Practice Address - Phone:570-795-9015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP1600X
PAPC016851101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral