Provider Demographics
NPI:1356086482
Name:ROMAN TEJERA, MAILENE MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MAILENE
Middle Name:MARIE
Last Name:ROMAN TEJERA
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 1:162 CALLE HELIO
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-8866
Mailing Address - Country:US
Mailing Address - Phone:787-644-0743
Mailing Address - Fax:
Practice Address - Street 1:CARR 119 KM 5.5 INTERIOR, BO. PUENTE
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-0062
Practice Address - Country:US
Practice Address - Phone:787-644-0743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7260103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical