Provider Demographics
NPI:1760930838
Name:CARTAGENA, MARILOLI (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARILOLI
Middle Name:
Last Name:CARTAGENA
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:HC 3 BOX 24003
Mailing Address - Street 2:CALLE 360
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-9734
Mailing Address - Country:US
Mailing Address - Phone:787-892-2244
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 24003
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-9734
Practice Address - Country:US
Practice Address - Phone:787-892-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1945103T00000X, 103TC1900X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool