Provider Demographics
NPI:1275089864
Name:FORASTIERI VILLAMIL, CAROLINE M (PHD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:M
Last Name:FORASTIERI VILLAMIL
Suffix:
Gender:F
Credentials:PHD
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 361577
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-1577
Mailing Address - Country:US
Mailing Address - Phone:787-671-4647
Mailing Address - Fax:
Practice Address - Street 1:331 CALLE COLL Y TOSTE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4026
Practice Address - Country:US
Practice Address - Phone:787-671-4647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5668103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical