Provider Demographics
NPI:1902969611
Name:BERRIOS, JORGE ERNESTO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ERNESTO
Last Name:BERRIOS
Suffix:
Gender:M
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:PO BOX 7558
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7558
Mailing Address - Country:US
Mailing Address - Phone:787-370-8964
Mailing Address - Fax:787-743-7776
Practice Address - Street 1:252 CALLE SAN JORGE STE 307
Practice Address - Street 2:SAN JORGE MEDICAL BUILDING
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3240
Practice Address - Country:US
Practice Address - Phone:787-728-7775
Practice Address - Fax:787-728-7755
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2724103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical