Provider Demographics
NPI:1215354709
Name:MARRERO, JANICE (LCR, CRC)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:MARRERO
Suffix:
Gender:F
Credentials:LCR, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 AVE HOSTOS
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-1502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:787-805-5670
Practice Address - Street 1:351 AVE HOSTOS
Practice Address - Street 2:SUITE 201
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1502
Practice Address - Country:US
Practice Address - Phone:787-361-8087
Practice Address - Fax:787-805-5670
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1264101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1264OtherLICENCE REHABILITATION COUNSELING