1215354709 NPI number — JANICE MARRERO LCR, CRC

Table of content: JANICE MARRERO LCR, CRC (NPI 1215354709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215354709 NPI number — JANICE MARRERO LCR, CRC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARRERO
Provider First Name:
JANICE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCR, CRC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215354709
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
351 AVE HOSTOS
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00680-1502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
787-805-5670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
351 AVE HOSTOS
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-1502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-361-8087
Provider Business Practice Location Address Fax Number:
787-805-5670
Provider Enumeration Date:
03/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  1264 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1264 . This is a "LICENCE REHABILITATION COUNSELING" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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