Provider Demographics
NPI:1174162903
Name:RUIZ PACHECO, SHARLEENE (PSYD)
Entity type:Individual
Prefix:
First Name:SHARLEENE
Middle Name:
Last Name:RUIZ PACHECO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SHARLEENE
Other - Middle Name:
Other - Last Name:RUIZ PACHECO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:3054 MANSIONES
Mailing Address - Street 2:CALLE MONACO C-33
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-519-8587
Mailing Address - Fax:
Practice Address - Street 1:PR #2 KM 159.0 AVENIDA HOSTOS 826
Practice Address - Street 2:EDIFICIO VILLA CAPITAN III SUITE 101
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:939-499-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-26
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6573103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty