Provider Demographics
NPI:1780574095
Name:GERENA, JUAN DANIEL SR (MA)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:DANIEL
Last Name:GERENA
Suffix:SR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 CALLE GLABRA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9269
Mailing Address - Country:US
Mailing Address - Phone:787-367-8433
Mailing Address - Fax:
Practice Address - Street 1:290 CALLE GLABRA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9269
Practice Address - Country:US
Practice Address - Phone:787-367-8433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7001103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling