Provider Demographics
NPI:1386131175
Name:GORRITZ, JAYLEEN
Entity type:Individual
Prefix:
First Name:JAYLEEN
Middle Name:
Last Name:GORRITZ
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:S21 URB THE CLUSTERS OCEAN BLUE LANE
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-242-0929
Mailing Address - Fax:
Practice Address - Street 1:CARR 695 KM 2.0 BO HIGUILLAR
Practice Address - Street 2:PLAZA DORAVILLE CARR
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-242-0929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5935103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist