Provider Demographics
NPI:1710463948
Name:HOMS, MARIAN TERESA (PSYD)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:TERESA
Last Name:HOMS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1565
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-1565
Mailing Address - Country:US
Mailing Address - Phone:787-383-7211
Mailing Address - Fax:
Practice Address - Street 1:22 CAYO ENRIQUE COURT
Practice Address - Street 2:BO LA PARGUERA
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667
Practice Address - Country:US
Practice Address - Phone:787-383-7211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6067103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical