1235848060 NPI number — STEPHANIE ODALYS CARRILLO NIEVES PSY.D.

Table of content: STEPHANIE ODALYS CARRILLO NIEVES PSY.D. (NPI 1235848060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235848060 NPI number — STEPHANIE ODALYS CARRILLO NIEVES PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARRILLO NIEVES
Provider First Name:
STEPHANIE
Provider Middle Name:
ODALYS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARRILLO NIEVES
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
ODALYS
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1235848060
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB. LOS PINOS I
Provider Second Line Business Mailing Address:
CALLE PINO MARITIMO #306
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-562-5757
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIFICIO ARECIBO MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
AVE. JOSE CELSO BARBOSA #65, SUITE 103
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612-0061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-562-5757
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  6749 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)