Provider Demographics
NPI:1104707579
Name:MARIN PELAEZ, CARMEN E
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:E
Last Name:MARIN PELAEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 CALLE SAN LUCAS
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-8515
Mailing Address - Country:US
Mailing Address - Phone:787-469-2623
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA FONT MARTELO
Practice Address - Street 2:LOCAL 2-E
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-9998
Practice Address - Country:US
Practice Address - Phone:787-285-3978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006665103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty