Healthcare Provider Details

I. General information

NPI: 1215030382
Provider Name (Legal Business Name): NELSON BARRIOS FELICIANO PSICOLOGO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1879 CALLE FERMIN ZEDO URB FAIR VIEW
SAN JUAN PR
00926-7627
US

V. Phone/Fax

Practice location:
  • Phone: 787-364-9688
  • Fax: 939-697-6003
Mailing address:
  • Phone: 787-364-9688
  • Fax: 939-697-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1846
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: