Provider Demographics
NPI:1619155975
Name:RODRIGUEZ-BERTRAN, MARIE (PSY D)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:RODRIGUEZ-BERTRAN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PLAZAS DE TORRIMAR 1 5109
Mailing Address - Street 2:110 AVE LOS FILTROS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-557-9546
Mailing Address - Fax:
Practice Address - Street 1:1666 AVE PARANA LOCAL 202
Practice Address - Street 2:URB. EL CEREZAL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-0092
Practice Address - Country:US
Practice Address - Phone:787-557-9546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
PR3032103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist