Provider Demographics
NPI:1801016175
Name:SOSA, MAYRA J (MS)
Entity Type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:J
Last Name:SOSA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2772
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-2772
Mailing Address - Country:US
Mailing Address - Phone:787-864-0216
Mailing Address - Fax:787-866-0909
Practice Address - Street 1:CALLE BALDORIOTY 6-E
Practice Address - Street 2:EDIFICIO PROFESIONAL
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-0216
Practice Address - Fax:787-866-0909
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1228103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical