Healthcare Provider Details

I. General information

NPI: 1336746593
Provider Name (Legal Business Name): JOMARY CARRERAS SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SECTOR LOS MENDEZ CARR 682 KM 3.9 INT
BARCELONETA PR
00617
US

IV. Provider business mailing address

HC 1 BOX 5120
BARCELONETA PR
00617-9508
US

V. Phone/Fax

Practice location:
  • Phone: 787-454-1736
  • Fax:
Mailing address:
  • Phone: 787-454-1736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6626
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: