Provider Demographics
NPI:1396955936
Name:CARRERO, MADELINE (PSYD)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:CARRERO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVENIDA HOSTO 180-190
Mailing Address - Street 2:CONDOMINIO MONTE SUR
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-364-7636
Mailing Address - Fax:
Practice Address - Street 1:URB. SANTIAGO IGLESIAS
Practice Address - Street 2:AVENIDA PAZ GRANELA # 1753
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-596-8201
Practice Address - Fax:787-766-0813
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1601103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist