Provider Demographics
NPI:1053667345
Name:CARABALLO, NANCY (DR)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:CARABALLO
Suffix:
Gender:F
Credentials:DR
Other - Prefix:DR
Other - First Name:CARABALLO
Other - Middle Name:
Other - Last Name:NANCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:RES MANUEL J RIVERA
Mailing Address - Street 2:EDIF 1 APT 7
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-2942
Mailing Address - Country:US
Mailing Address - Phone:787-638-2803
Mailing Address - Fax:
Practice Address - Street 1:117 CALLE DIOSDADO DONES
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-2571
Practice Address - Country:US
Practice Address - Phone:787-638-2803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2732103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist