Provider Demographics
NPI:1174009161
Name:SERRANO RIOS, JENNIFER M (PSYD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:SERRANO RIOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 CALLE TOPACIO
Mailing Address - Street 2:MANSIONES DEL CARIBE
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-940-1480
Mailing Address - Fax:
Practice Address - Street 1:73 EDIFICIO SANTA CRUZ
Practice Address - Street 2:CALLE SANTA CRUZ SUITE 303
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6919
Practice Address - Country:US
Practice Address - Phone:787-590-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006165103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty