Provider Demographics
NPI:1790944767
Name:AYALA CHARRIEZ, MARIA DEL MAR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIA DEL MAR
Middle Name:
Last Name:AYALA CHARRIEZ
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:D6 CALLE 2
Mailing Address - Street 2:COLINAS VERDES
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:787-400-2999
Mailing Address - Fax:
Practice Address - Street 1:AVE JESUS T PINERO #265
Practice Address - Street 2:URB HYDE PARK APT #2
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-400-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2161103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical