Provider Demographics
NPI:1386448470
Name:MIRABAL, GRECIA NOELIA
Entity type:Individual
Prefix:
First Name:GRECIA
Middle Name:NOELIA
Last Name:MIRABAL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 CALLE ARAGON
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-5315
Mailing Address - Country:US
Mailing Address - Phone:787-470-9858
Mailing Address - Fax:
Practice Address - Street 1:606 CALLE ARAGON
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-5315
Practice Address - Country:US
Practice Address - Phone:787-470-9858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8324103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical