Provider Demographics
NPI:1104397363
Name:HERNANDEZ PEREZ, MARIA DEL CARMEN (MA PSY)
Entity Type:Individual
Prefix:MRS
First Name:MARIA DEL CARMEN
Middle Name:
Last Name:HERNANDEZ PEREZ
Suffix:
Gender:F
Credentials:MA PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 11954
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-9728
Mailing Address - Country:US
Mailing Address - Phone:787-409-6270
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 8.2
Practice Address - Street 2:BO JUAN SANCHEZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-763-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3765103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist