Provider Demographics
NPI:1366735615
Name:RIVERA-CARRASQUILLO, MARIELY (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIELY
Middle Name:
Last Name:RIVERA-CARRASQUILLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:# 458 CAMINO LOS UCARES
Mailing Address - Street 2:SABANERA DEL RIO
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-745-1196
Mailing Address - Fax:
Practice Address - Street 1:CAMINO LOS UCARES 458
Practice Address - Street 2:SABANERA DEL RIO
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-0077
Practice Address - Country:US
Practice Address - Phone:787-745-1196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3932103TC0700X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical