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General NPI Number Information
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NPI Number | 1477005726
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Entity Type | Individual
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Provider Name | SHERITZA G. CARRASQUILLO DIAZ PSY.D
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Gender | Female
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Dates
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Enumeration Date | 11/02/2016
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | URB. EXT. CAMPO ALEGRE G25 CALLE ALELI
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City | BAYAMON
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State | PR
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Zip | 00956-4420
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Country | US
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Telephone | 939-338-3659
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Fax |
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Provider Business Mailing Address
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Address Line | G25 CALLE ALELI URBANIZACION EXTENSION CAMPO ALEGRE
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City | BAYAMON
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State | PR
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Zip | 00956-4420
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Country | US
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Telephone | 787-667-7059
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 5650
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License Number State | PR
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