Provider Demographics
NPI:1477864270
Name:SOUCHET, MAILEEN (PHD)
Entity Type:Individual
Prefix:
First Name:MAILEEN
Middle Name:
Last Name:SOUCHET
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:COND TOWNHOUSE
Mailing Address - Street 2:APT. 1804
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-3312
Mailing Address - Country:US
Mailing Address - Phone:787-449-7498
Mailing Address - Fax:787-287-1731
Practice Address - Street 1:EMILIANO POL
Practice Address - Street 2:265
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5102
Practice Address - Country:US
Practice Address - Phone:787-449-7498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3429103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical