Provider Demographics
NPI:1548454333
Name:BERRIOS, CARLOS MIGUEL (MA)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:MIGUEL
Last Name:BERRIOS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 FLAMINGO HILLS
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-1747
Mailing Address - Country:US
Mailing Address - Phone:787-457-8573
Mailing Address - Fax:787-780-5162
Practice Address - Street 1:URB.FLAMINGO HILLS #106 CALLE4
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-1747
Practice Address - Country:US
Practice Address - Phone:787-457-8573
Practice Address - Fax:787-780-5162
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2231103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist