=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720311103
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSELYN ALVARADO MARRERO PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2009
-----------------------------------------------------
Last Update Date | 11/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARRETERA 149 KM 58.0 ED. SAN GERALDO SUITE 207G
-----------------------------------------------------
City | VILLALBA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-847-6700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CARRETERA 702 BUZON #23
-----------------------------------------------------
City | COAMO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-317-4155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 3185
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------