Basic Information
| Provider Information | |||||||||
| NPI: | 1346594512 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARCIA-MERCADO | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | NORBERTO | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MSW, LICSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GARCIA | ||||||||
| OtherFirstName: | JOSE | ||||||||
| OtherMiddleName: | N | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MSW, LICSW | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1 SPRINGFIELD ST APT 218 | ||||||||
| Address2: | |||||||||
| City: | CHICOPEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010132664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137779952 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 417 LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011043736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137470705 | ||||||||
| FaxNumber: | 4137327075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2012 | ||||||||
| LastUpdateDate: | 04/01/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1303295 | 05 | MA | MEDICAID | 1303295 | 01 | MA | MBHP | OTHER | 12529 | 01 | MA | HEALTH NEW ENGLAND | OTHER | 71756 | 01 | MA | TUFTS | OTHER | 8443 | 01 | MA | BMC/BEACON | OTHER | 042622756 | 01 | MA | COMMONWEALTH CARE ALLIANCE | OTHER | 997303 | 01 | MA | NETWORK HEALTH | OTHER |