Provider Demographics
NPI:1417379405
Name:ANDINO SERRANO, ANDRES RAUL (MPSY)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:RAUL
Last Name:ANDINO SERRANO
Suffix:
Gender:M
Credentials:MPSY
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 604
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-0604
Mailing Address - Country:US
Mailing Address - Phone:787-220-1272
Mailing Address - Fax:
Practice Address - Street 1:CONCORDIA SHOPPING CENTER
Practice Address - Street 2:AVE. 65TH INFANTERIA BO. SABANA LLANA SUR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-0000
Practice Address - Country:US
Practice Address - Phone:787-220-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004195101YP2500X
PR005172103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional