Provider Demographics
NPI:1982277141
Name:CARRION, JETZABEL
Entity Type:Individual
Prefix:MRS
First Name:JETZABEL
Middle Name:
Last Name:CARRION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 31609
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-9795
Mailing Address - Country:US
Mailing Address - Phone:787-356-5276
Mailing Address - Fax:
Practice Address - Street 1:PR 2 KM 69.5
Practice Address - Street 2:BO SANTANA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-640-4913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty