MEDICARE: DR. VANESSA BERRIOS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1177	PR

General Provider Information

NPI Number	:	1962539510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANESSA BERRIOS PHD

Provider Business Mailing Address
First Line	:	PO BOX 801202
Second Line	:	COTO LAUREL
City	:	PONCE
State	:	PR
Zip	:	00780-1202
Country	:	US
Telephone Number	:	787-848-1010
Fax Number	:

Provider Business Practice Location Address
First Line	:	CENTRO CIRUGIA CARDIOVASCULAR HOSPITAL DAMAS
Second Line	:	SUITE 2DO PISO 2213 PONCE BY PASS
City	:	PONCE
State	:	PR
Zip	:	00717-1318
Country	:	US
Telephone Number	:	787-848-1010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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