MEDICARE: THALIAN M RAMOS ROLDAN 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	8845	PR

General Provider Information

NPI Number	:	1649139098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THALIAN M RAMOS ROLDAN PSY.D

Provider Business Mailing Address
First Line	:	URB. BELLO HORIZONTE CALLE 3 F-36
Second Line	:
City	:	GUAYAMA
State	:	PR
Zip	:	00784
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	URB. BELLO HORIZONTE CALLE 3 F-25 ALTOS
Second Line	:
City	:	GUAYAMA
State	:	PR
Zip	:	00784
Country	:	US
Telephone Number	:	939-207-4852
Fax Number	:

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

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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