Provider Demographics
NPI:1104262765
Name:BRIGNONI, MARILDA (MA)
Entity type:Individual
Prefix:MISS
First Name:MARILDA
Middle Name:
Last Name:BRIGNONI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 38014
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9329
Mailing Address - Country:US
Mailing Address - Phone:787-587-5467
Mailing Address - Fax:
Practice Address - Street 1:HC 2 BOX 38014
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-9329
Practice Address - Country:US
Practice Address - Phone:787-587-5467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4080103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling