Provider Demographics
NPI:1477005726
Name:CARRASQUILLO DIAZ, SHERITZA G (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHERITZA
Middle Name:G
Last Name:CARRASQUILLO DIAZ
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:G25 CALLE ALELI
Mailing Address - Street 2:URBANIZACION EXTENSION CAMPO ALEGRE
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4420
Mailing Address - Country:US
Mailing Address - Phone:787-667-7059
Mailing Address - Fax:
Practice Address - Street 1:URB. EXT. CAMPO ALEGRE
Practice Address - Street 2:G25 CALLE ALELI
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4420
Practice Address - Country:US
Practice Address - Phone:939-338-3659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5650103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling