Provider Demographics
NPI:1164826855
Name:CARABALLO-RODRIGUEZ, MERCEDES
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:CARABALLO-RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MERCEDES
Other - Middle Name:C
Other - Last Name:DE RADINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NCC
Mailing Address - Street 1:1574 CALLE BORI
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6113
Mailing Address - Country:US
Mailing Address - Phone:787-545-4111
Mailing Address - Fax:787-545-4111
Practice Address - Street 1:1574 CALLE BORI
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6113
Practice Address - Country:US
Practice Address - Phone:787-545-4111
Practice Address - Fax:787-545-4111
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR903101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health