Provider Demographics
NPI:1104665637
Name:RAMOS SEGARRA, GENESIS MARIE (LP)
Entity type:Individual
Prefix:MISS
First Name:GENESIS
Middle Name:MARIE
Last Name:RAMOS SEGARRA
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE SAN IGNACIO #502
Mailing Address - Street 2:URB. SANTA RITA I
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2277
Mailing Address - Country:US
Mailing Address - Phone:787-342-8162
Mailing Address - Fax:
Practice Address - Street 1:2984 AVE EMILIO FAGOT
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-3615
Practice Address - Country:US
Practice Address - Phone:787-546-5315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7846103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling