Provider Demographics
NPI:1164662227
Name:RESTO, MARIA CARMEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:CARMEN
Last Name:RESTO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:CARMEN
Other - Last Name:RESTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSY D
Mailing Address - Street 1:46 CALLE AGUADILLA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-4816
Mailing Address - Country:US
Mailing Address - Phone:787-765-6184
Mailing Address - Fax:787-765-6184
Practice Address - Street 1:46 CALLE AGUADILLA PEREZ MORRIS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-4816
Practice Address - Country:US
Practice Address - Phone:787-765-6184
Practice Address - Fax:787-765-6184
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3288103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist