Provider Demographics
NPI:1245273606
Name:MARCOS, IRMA M
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:M
Last Name:MARCOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 AVE SAN IGNACIO
Mailing Address - Street 2:COND VISTA VERDE APT 101
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-3818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1329 AVE SAN IGNACIO
Practice Address - Street 2:COND VISTA VERDE APT 101
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3818
Practice Address - Country:US
Practice Address - Phone:787-379-9600
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2008103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist