Provider Demographics
NPI:1255892386
Name:FUSTER, IRIS (LICENSEDPSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:FUSTER
Suffix:
Gender:F
Credentials:LICENSEDPSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:F11 CALLE GENOVA
Mailing Address - Street 2:VILLA CAPARRA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-1727
Mailing Address - Country:US
Mailing Address - Phone:787-603-0459
Mailing Address - Fax:
Practice Address - Street 1:56 CALLE BORINQUENA
Practice Address - Street 2:URB. SANTA RITA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:787-603-0459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6215103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist