Healthcare Provider Details

I. General information

NPI: 1841895976
Provider Name (Legal Business Name): CARLOS ENRIQUE RIOLLANO BAYOUTH PHD, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WAUWINET TRL
GUILFORD CT
06437-1152
US

IV. Provider business mailing address

104 WAUWINET TRL
GUILFORD CT
06437-1152
US

V. Phone/Fax

Practice location:
  • Phone: 787-717-8466
  • Fax:
Mailing address:
  • Phone: 787-717-8466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number005675
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: