Provider Demographics
NPI:1780980706
Name:CARABALLO, NILDA VIOLETA (PSYD)
Entity type:Individual
Prefix:
First Name:NILDA
Middle Name:VIOLETA
Last Name:CARABALLO
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:#20 CALLE ROCIO
Mailing Address - Street 2:PASEO DE LAS BRUMAS
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-9350
Mailing Address - Country:US
Mailing Address - Phone:787-810-9505
Mailing Address - Fax:
Practice Address - Street 1:818 AVE. ITURREGUI
Practice Address - Street 2:CALLE MOLUCAS ALTOS COUNTRY CLUB
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-768-0390
Practice Address - Fax:787-768-1775
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3857103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist