Provider Demographics
NPI:1770808776
Name:MARENGO, JESSICA ANGELA (MPSY, CPF)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANGELA
Last Name:MARENGO
Suffix:
Gender:F
Credentials:MPSY, CPF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. ALTURAS DE INTERAMERICANA #R-1 CALLE 12
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-3210
Mailing Address - Country:US
Mailing Address - Phone:787-459-0735
Mailing Address - Fax:
Practice Address - Street 1:23-7 AVE ROBERTO CLEMENTE
Practice Address - Street 2:VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5413
Practice Address - Country:US
Practice Address - Phone:939-639-2629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3423103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling