Provider Demographics
NPI:1083056865
Name:JIMENEZ CARRION, RAUL EDGARDO (PSY D)
Entity Type:Individual
Prefix:MR
First Name:RAUL
Middle Name:EDGARDO
Last Name:JIMENEZ CARRION
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:RAUL
Other - Middle Name:EDGARDO
Other - Last Name:JIMENEZ CARRION
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:HC 1 BOX 3740
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-9610
Mailing Address - Country:US
Mailing Address - Phone:787-201-3971
Mailing Address - Fax:
Practice Address - Street 1:ARECIBO MEDICAL CENTER
Practice Address - Street 2:SUITE 108 CARRETERA #2 KM 80
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-201-3971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5813103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical