Healthcare Provider Details

I. General information

NPI: 1720578719
Provider Name (Legal Business Name): KIMBERLY CARRION ALICEA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB VILLA HILDA D3
YABUCOA PR
00767-0000
US

IV. Provider business mailing address

VILLA NEVAREZ 1135 CALLE 5 STE 1
SAN JUAN PR
00927-5166
US

V. Phone/Fax

Practice location:
  • Phone: 939-489-6744
  • Fax:
Mailing address:
  • Phone: 939-489-6744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7133
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: