Healthcare Provider Details

I. General information

NPI: 1598390338
Provider Name (Legal Business Name): GREISA MARIE RAMOS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 140 KM 1.9 BO. MAGUEYES
BARCELONETA PR
00617
US

IV. Provider business mailing address

PO BOX 797
HATILLO PR
00659-0797
US

V. Phone/Fax

Practice location:
  • Phone: 787-242-4056
  • Fax:
Mailing address:
  • Phone: 787-242-4056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6412
License Number StatePR

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: