Provider Demographics
NPI:1376826263
Name:CARRASQUILLO, SAMARY (MS SLP)
Entity Type:Individual
Prefix:
First Name:SAMARY
Middle Name:
Last Name:CARRASQUILLO
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 E-33 JARDINES DE CANOVANAS
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:P.R.
Mailing Address - Zip Code:00729
Mailing Address - Country:UM
Mailing Address - Phone:787-556-0196
Mailing Address - Fax:
Practice Address - Street 1:351 CALLE GRANADA
Practice Address - Street 2:URB LOS ARBOLES
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-5355
Practice Address - Country:US
Practice Address - Phone:787-556-0196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR880235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist