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General NPI Number Information
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NPI Number | 1699590208
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Entity Type | Organization
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Legal Business Name | MARIEL ADORNO PSYCHOLOGICAL & PROFESSIONAL GROUP, CSP
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | CARR 10 R651 KM 2.4 SEC EL JUNCO BO. JUNCOS
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City | ARECIBO
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State | PR
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Zip | 00612-0000
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Country | US
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Telephone | 787-956-0062
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1608
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City | ARECIBO
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State | PR
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Zip | 00613-1608
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Country | US
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Telephone | 787-214-9887
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Fax |
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Authorized Official
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Title or Position | OWNER / PSYCHOLOGIST
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Name | MARIEL ADORNO DIAZ
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Credential | M.A.
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Telephone | 787-956-0062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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