Provider Demographics
NPI:1134660335
Name:MANGUAL, MARIBEL (PSYD)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:MANGUAL
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 1:1224 AVE MUNOZ RIVERA
Mailing Address - Street 2:REPARTO UNIVERSITARIO
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0639
Mailing Address - Country:US
Mailing Address - Phone:787-231-3323
Mailing Address - Fax:
Practice Address - Street 1:1224 AVE MUNOZ RIVERA
Practice Address - Street 2:REPARTO UNIVERSITARIO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0639
Practice Address - Country:US
Practice Address - Phone:787-231-3323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5823103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical