Healthcare Provider Details

I. General information

NPI: 1871416149
Provider Name (Legal Business Name): JAILEEN M STUART NAZARIO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE BETANCES #15
SANTA ISABEL PR
00757
US

IV. Provider business mailing address

URB. COLINAS DE VERDE AZUL, #44, CALLE SIENA
JUANA DIAZ PR
00795
US

V. Phone/Fax

Practice location:
  • Phone: 787-424-6658
  • Fax:
Mailing address:
  • Phone: 787-424-6658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8923
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: