Provider Demographics
NPI:1114159167
Name:CARRION-BARALT, JOSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:CARRION-BARALT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 CALLE CARIBE
Mailing Address - Street 2:URB FLORAL PARK
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-3517
Mailing Address - Country:US
Mailing Address - Phone:787-312-8254
Mailing Address - Fax:
Practice Address - Street 1:422 CALLE CARIBE
Practice Address - Street 2:URB FLORAL PARK
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3517
Practice Address - Country:US
Practice Address - Phone:787-312-8254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1807103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical