Provider Demographics
NPI:1316614076
Name:RULLAN FERRER, LAURIE JANICE (PSYD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:JANICE
Last Name:RULLAN FERRER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 BLVD MEDIA LUNA APT 1604 COND. VEREDAS DEL PARQUE
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AGUADILLA MEDICAL SERVICES
Practice Address - Street 2:CARR. 2 KM 129.3 SUITE 206
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-4728
Practice Address - Country:US
Practice Address - Phone:787-314-3680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7068103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical