Provider Demographics
NPI:1720537012
Name:DYER, TANYA (PSY/MA)
Entity Type:Individual
Prefix:MISS
First Name:TANYA
Middle Name:
Last Name:DYER
Suffix:
Gender:F
Credentials:PSY/MA
Other - Prefix:MISS
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:DYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSY/MA
Mailing Address - Street 1:PO BOX 11264
Mailing Address - Street 2:STA. SAN JUAN, PR
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-2364
Mailing Address - Country:US
Mailing Address - Phone:787-602-6502
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO PLAZA DEL CONDADO 62-64
Practice Address - Street 2:CONDADO, PR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-602-6502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2844103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling