Provider Demographics
NPI:1154892685
Name:ORENGO, KEYLIVETTE (MS)
Entity type:Individual
Prefix:MRS
First Name:KEYLIVETTE
Middle Name:
Last Name:ORENGO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 COLINAS DEL SOL 1 ST 4
Mailing Address - Street 2:APT 1711
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-215-2574
Mailing Address - Fax:
Practice Address - Street 1:17 COLINAS DEL SOL 1 ST 4
Practice Address - Street 2:APT 1711
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-215-2574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1699103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty