Healthcare Provider Details

I. General information

NPI: 1770808776
Provider Name (Legal Business Name): JESSICA ANGELA MARENGO MPSY, CPF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23-7 AVE ROBERTO CLEMENTE VILLA CAROLINA
CAROLINA PR
00985-5413
US

IV. Provider business mailing address

URB. ALTURAS DE INTERAMERICANA #R-1 CALLE 12
TRUJILLO ALTO PR
00976-3210
US

V. Phone/Fax

Practice location:
  • Phone: 939-639-2629
  • Fax:
Mailing address:
  • Phone: 787-459-0735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3423
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: