Healthcare Provider Details

I. General information

NPI: 1538352398
Provider Name (Legal Business Name): JUAN ALBERTO NAZARIO PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#122 ELEONOR ROOSEVELT
HATO REY PR
00917
US

IV. Provider business mailing address

DE DIEGO CHALETS 474 CALLE DE DIEGO APT.108
SAN JUAN PR
00923-3137
US

V. Phone/Fax

Practice location:
  • Phone: 787-478-3803
  • Fax:
Mailing address:
  • Phone: 787-478-3803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number1920
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number1920
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1920
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1920
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1920
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number1920
License Number StatePR
# 7
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number1920
License Number StatePR
# 8
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number1920
License Number StatePR
# 9
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number1920
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: