Provider Demographics
NPI:1194039271
Name:CARABALLO, MIRTA
Entity type:Individual
Prefix:
First Name:MIRTA
Middle Name:
Last Name:CARABALLO
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:ORQUIDEA ST SEGUNDA EXTENSION SANTA ELENA 00656
Mailing Address - Street 2:B3
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656
Mailing Address - Country:US
Mailing Address - Phone:787-835-3083
Mailing Address - Fax:
Practice Address - Street 1:ORQUIDEA ST SEGUNDA EXTENSION SANTA ELENA 00656
Practice Address - Street 2:B3
Practice Address - City:GUAYANILLA
Practice Address - State:PR
Practice Address - Zip Code:00656-0000
Practice Address - Country:US
Practice Address - Phone:787-835-3083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)