Provider Demographics
NPI:1679914311
Name:CARRASCO, MELISSA (PHD CLINICAL PSYCH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CARRASCO
Suffix:
Gender:F
Credentials:PHD CLINICAL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LOS CAOBOS PLZ APT 501
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-4416
Mailing Address - Country:US
Mailing Address - Phone:787-624-3366
Mailing Address - Fax:
Practice Address - Street 1:SANTA ROSA III
Practice Address - Street 2:CALLE FICUS A-1. CARR 833, KM 2.2
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-435-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR5773103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program