Provider Demographics
NPI:1245512698
Name:SERRANO, MAGALY (MA)
Entity type:Individual
Prefix:
First Name:MAGALY
Middle Name:
Last Name:SERRANO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CONDOMINIO FLORIMAR GARDENS
Mailing Address - Street 2:APT G 402
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5249
Mailing Address - Country:US
Mailing Address - Phone:787-368-7123
Mailing Address - Fax:
Practice Address - Street 1:CONDOMINIO ADA LIGIA, SUITE 408 1452 AVE. ASHFORD
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-368-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3060103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical