Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | ||
N | 103TC0700X | Clinical Psychologist | ||
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist | ||
N | 103TH0100X | Health Service | ||
N | 103TP2701X | Group Psychotherapist |
NPI | 1588238380 |
---|---|
Provider Name | Juan A Serrano |
First Address | Aguada, PR 00602-9755 |
Second Address | Meridian, ID 83642-5210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2021 |
Last Update Date | 17/05/2021 |