Provider Demographics
NPI:1447964952
Name:MERCURY THERAPY SERVICES CORP
Entity type:Organization
Organization Name:MERCURY THERAPY SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDES LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-457-5321
Mailing Address - Street 1:12150 SW 128TH CT STE 207
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4667
Mailing Address - Country:US
Mailing Address - Phone:305-457-5321
Mailing Address - Fax:
Practice Address - Street 1:12150 SW 128TH CT STE 207
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4667
Practice Address - Country:US
Practice Address - Phone:305-457-5321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty