Provider Demographics
NPI:1487861415
Name:CHICO, CARMEN ROSARIO (MS)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:ROSARIO
Last Name:CHICO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1084 CALLE 15
Mailing Address - Street 2:VILLA NEVAREZ
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-5318
Mailing Address - Country:US
Mailing Address - Phone:787-756-5431
Mailing Address - Fax:
Practice Address - Street 1:CENTRO METADONA SAN JUAN
Practice Address - Street 2:PABELLON G CENTRO MEDICO
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00927-5318
Practice Address - Country:US
Practice Address - Phone:787-767-9243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001134103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical