Provider Demographics
NPI:1851606859
Name:MILLAN CARRERO, EDDIE WILLIAM (PH D)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:WILLIAM
Last Name:MILLAN CARRERO
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE HACIENDA REAL #85
Mailing Address - Street 2:URB. CAMINO REAL
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795
Mailing Address - Country:US
Mailing Address - Phone:787-380-1419
Mailing Address - Fax:
Practice Address - Street 1:CALLE HACIENDA REAL #85
Practice Address - Street 2:URB. CAMINO REAL
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-0000
Practice Address - Country:US
Practice Address - Phone:787-380-1419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3261103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical