Provider Demographics
NPI:1841767860
Name:ROMAN-MARRERO, ANNETTE D (MS)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:D
Last Name:ROMAN-MARRERO
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 1:525 CALLE CUEVAS BUSTAMANTE
Mailing Address - Street 2:PARQ CENTRAL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2642
Mailing Address - Country:US
Mailing Address - Phone:787-614-9285
Mailing Address - Fax:
Practice Address - Street 1:525 CALLE CUEVAS BUSTAMANTE
Practice Address - Street 2:PARQ CENTRAL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2642
Practice Address - Country:US
Practice Address - Phone:787-614-9285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7617103TB0200X, 103TF0000X, 103TM1800X, 103T00000X
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7617OtherPSYCHOLOGY
PR1396147724Medicaid