Provider Demographics
NPI:1225461833
Name:SERRANO, MARYLEIN (THL)
Entity Type:Individual
Prefix:
First Name:MARYLEIN
Middle Name:
Last Name:SERRANO
Suffix:
Gender:F
Credentials:THL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 72 BOX 4034
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-8784
Mailing Address - Country:US
Mailing Address - Phone:787-462-1779
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA SAN PATRICIO NUMERO 826 URBANIZACION LAS LOMAS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00922
Practice Address - Country:UM
Practice Address - Phone:787-782-1058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR30012355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant