Provider Demographics
NPI:1013137793
Name:IRIZARRY, MYRIA A (MS)
Entity Type:Individual
Prefix:
First Name:MYRIA
Middle Name:A
Last Name:IRIZARRY
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:BE28 CALLE RIO AMAZONAS
Mailing Address - Street 2:URB.VALLE VERDE,
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3273
Mailing Address - Country:US
Mailing Address - Phone:787-403-2899
Mailing Address - Fax:
Practice Address - Street 1:BE28 CALLE RIO AMAZONAS
Practice Address - Street 2:URB.VALLE VERDE,
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3273
Practice Address - Country:US
Practice Address - Phone:787-403-2899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR174103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical