Provider Demographics
NPI:1427007467
Name:MARIN, INGRID C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:C
Last Name:MARIN
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:PARQUE TIERRA LINDA APT. 1901
Mailing Address - Street 2:LAGO ALTO
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1901
Mailing Address - Country:US
Mailing Address - Phone:787-646-5505
Mailing Address - Fax:
Practice Address - Street 1:222 1 ROBERTO CLEMENTE
Practice Address - Street 2:VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-752-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2336103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRQ-66948Medicare UPIN
PR0057206Medicare ID - Type Unspecified