Provider Demographics
NPI:1114350006
Name:SERRANO, CAROLYN K
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:K
Last Name:SERRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 141832
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-1832
Mailing Address - Country:US
Mailing Address - Phone:787-454-2356
Mailing Address - Fax:787-898-7094
Practice Address - Street 1:CALLE ALMENDRA G18
Practice Address - Street 2:URB ESTANCIA DE LA CEIBA
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-454-2356
Practice Address - Fax:787-898-7094
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4811103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist