Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 4080 | PR |
NPI | 1104262765 |
---|---|
Provider Name | Miss Marilda Brignoni |
First Address | Arecibo, PR 00612-9329 |
Second Address | Arecibo, PR 00612-9329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2013 |
Last Update Date | 21/05/2013 |