Provider Demographics
NPI:1770714073
Name:VERA, MILDRED (PHD)
Entity type:Individual
Prefix:DR
First Name:MILDRED
Middle Name:
Last Name:VERA
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:QG21 CALLE 527
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-2016
Mailing Address - Country:US
Mailing Address - Phone:787-762-3155
Mailing Address - Fax:
Practice Address - Street 1:QG21 CALLE 527
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-2016
Practice Address - Country:US
Practice Address - Phone:787-762-3155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR133103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical