Provider Demographics
NPI:1023249901
Name:SALAS-SERRANO, CARMEN CECILIA
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:CECILIA
Last Name:SALAS-SERRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 141784
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-1784
Mailing Address - Country:US
Mailing Address - Phone:787-617-6461
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 2 KILOMETRO 81.1
Practice Address - Street 2:SECTOR SAN DANIEL
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-617-6461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2091103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical