Provider Demographics
NPI:1891001814
Name:LIBOY-RIOS, JENNYMIR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNYMIR
Middle Name:
Last Name:LIBOY-RIOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 22
Mailing Address - Street 2:S7 VISTA AZUL
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-3128
Mailing Address - Country:US
Mailing Address - Phone:787-473-4926
Mailing Address - Fax:787-879-2098
Practice Address - Street 1:CALLE 22
Practice Address - Street 2:S7 VISTA AZUL
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-3128
Practice Address - Country:US
Practice Address - Phone:787-473-4926
Practice Address - Fax:787-879-2098
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR03769103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical