Provider Demographics
NPI:1790946077
Name:SOSA, IRMALY (MA)
Entity Type:Individual
Prefix:
First Name:IRMALY
Middle Name:
Last Name:SOSA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 AVE PINERO
Mailing Address - Street 2:2-O COND. HATO REY PLAZA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4109
Mailing Address - Country:US
Mailing Address - Phone:787-375-1388
Mailing Address - Fax:
Practice Address - Street 1:200 AVE PINERO
Practice Address - Street 2:2-O COND. HATO REY PLAZA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4109
Practice Address - Country:US
Practice Address - Phone:787-375-1388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002508103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist