Healthcare Provider Details

I. General information

NPI: 1174442206
Provider Name (Legal Business Name): JOMARIE ENID CARABALLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE ROCHELAISES
MAYAGUEZ PR
00681
US

IV. Provider business mailing address

PARCELAS CASTILLO CALLE DOMINGO SILVA G1
MAYAGUEZ PR
00682
US

V. Phone/Fax

Practice location:
  • Phone: 787-424-3185
  • Fax:
Mailing address:
  • Phone: 787-519-6149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number008359
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: