Healthcare Provider Details

I. General information

NPI: 1275946139
Provider Name (Legal Business Name): NILMARIE MATOS FRADERA PSICOLOGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 01/24/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILLA BLANCA CALLE ACERINA 2
CAGUAS PR
00725
US

IV. Provider business mailing address

VILLA BLANCA CALLE ACERINA 2
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 787-900-3983
  • Fax:
Mailing address:
  • Phone: 787-900-3983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number5223
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5223
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number5223
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5223
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: