Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 4084 | PR |
NPI | 1043589377 |
---|---|
Provider Name | Carmen Chacon-Orengo |
First Address | Garrochales, PR 00652-0513 |
Second Address | Arecibo, PR 00612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2011 |
Last Update Date | 22/04/2013 |