Provider Demographics
NPI:1003085622
Name:BURGOS CARRION, MARIA DE LOS A (PSYD)
Entity Type:Individual
Prefix:
First Name:MARIA DE LOS
Middle Name:A
Last Name:BURGOS CARRION
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 AVE PRINCIPAL
Mailing Address - Street 2:URBANIZACION BAY VIEW
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00962-4269
Mailing Address - Country:US
Mailing Address - Phone:787-667-3546
Mailing Address - Fax:
Practice Address - Street 1:16 CALLE PRINCIPAL
Practice Address - Street 2:URBANIZACION BAY VIEW
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-4269
Practice Address - Country:US
Practice Address - Phone:787-667-3546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2942103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical