Provider Demographics
NPI:1861722720
Name:CARRILLO, NORMA (MD)
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 ESTATE RICHMOND CHARLES HARWOOD COMPLEX
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4370
Mailing Address - Country:US
Mailing Address - Phone:340-773-1311
Mailing Address - Fax:
Practice Address - Street 1:3500 ESTATE RICHMOND
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4370
Practice Address - Country:US
Practice Address - Phone:340-773-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1043103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist