Provider Demographics
NPI:1508270208
Name:SERRANO, SUSSANE (MA PSY)
Entity Type:Individual
Prefix:
First Name:SUSSANE
Middle Name:
Last Name:SERRANO
Suffix:
Gender:F
Credentials:MA PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 CALLE TRINIDAD ORELLANA
Mailing Address - Street 2:CONDOMINIO DOS PINOS APT 12
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-360-0705
Mailing Address - Fax:
Practice Address - Street 1:MUNOZ RIVERA ACUARELA 3
Practice Address - Street 2:KOI BLDG. G-10
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-360-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5597103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling