Provider Demographics
NPI:1013148659
Name:LARA, YAMIL J (PHD)
Entity Type:Individual
Prefix:DR
First Name:YAMIL
Middle Name:J
Last Name:LARA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 AVE GIRASOL
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-8723
Mailing Address - Country:US
Mailing Address - Phone:787-250-7280
Mailing Address - Fax:
Practice Address - Street 1:576 CALLE CESAR GONZALEZ STE 303
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3757
Practice Address - Country:US
Practice Address - Phone:787-250-7280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3247103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling