Provider Demographics
NPI:1457796849
Name:MELENDEZ, CARISSA (MS)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1792
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00951-1792
Mailing Address - Country:US
Mailing Address - Phone:787-200-8858
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 866 KM 1.1 LOTE 51 BO. CANDELARIA
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-0094
Practice Address - Country:US
Practice Address - Phone:787-200-8858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3333103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist