MEDICARE: JISSMAR BERRIOS PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	8650	PR

General Provider Information

NPI Number	:	1063004802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JISSMAR BERRIOS PSY.D.

Provider Business Mailing Address
First Line	:	HC 6 BOX 75866
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-9517
Country	:	US
Telephone Number	:	939-625-0437
Fax Number	:

Provider Business Practice Location Address
First Line	:	HC 6 BOX 75866
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-9517
Country	:	US
Telephone Number	:	939-625-0437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2021
Last Update Date	:	06/04/2026

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