Provider Demographics
NPI:1831297084
Name:OSSORIO, PEDRO J (MA)
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:J
Last Name:OSSORIO
Suffix:
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 1:89 CALLE VIVES
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-3648
Mailing Address - Country:US
Mailing Address - Phone:787-842-5290
Mailing Address - Fax:787-842-5290
Practice Address - Street 1:89 CALLE VIVES
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3648
Practice Address - Country:US
Practice Address - Phone:787-842-5290
Practice Address - Fax:787-842-5290
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR772103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical