Provider Demographics
NPI:1649757105
Name:COSS, MARIA I (PHD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:I
Last Name:COSS
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 1:173 CALLE DEL PARQUE APT B11
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-1975
Mailing Address - Country:US
Mailing Address - Phone:787-380-8955
Mailing Address - Fax:
Practice Address - Street 1:173 CALLE DEL PARQUE APT B11
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1975
Practice Address - Country:US
Practice Address - Phone:787-380-8955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6037103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical