Healthcare Provider Details

I. General information

NPI: 1780804013
Provider Name (Legal Business Name): MARUCA LLORENS QUINONES PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND. LAS TORRES NORTE PISO 3 OFICINA E-3
BAYAMON PR
00960
US

IV. Provider business mailing address

BOX 6400 PMB 395
CAYEY PR
00737-6400
US

V. Phone/Fax

Practice location:
  • Phone: 787-635-2656
  • Fax:
Mailing address:
  • Phone: 787-635-2656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number564
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2556
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: