Provider Demographics
NPI:1548755820
Name:VARGAS RIVERA, MARLYN V (PHD)
Entity Type:Individual
Prefix:
First Name:MARLYN
Middle Name:V
Last Name:VARGAS RIVERA
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:URBANIZACION MANSIONES DE CABO ROJO
Mailing Address - Street 2:32 CALLEPLAYA
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-602-9798
Mailing Address - Fax:
Practice Address - Street 1:CALLE MUNOZ RIVERA #31 ESQUINA BETANCES
Practice Address - Street 2:EDIF. DAGOBERTO MONTALVO SUITE #2
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-254-0396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6166103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty