Provider Demographics
NPI:1386976934
Name:GOMEZ- MILIAN, CARMEN M (PSYD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:M
Last Name:GOMEZ- MILIAN
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:URB. MANSIONES DE MONTE SERENO
Mailing Address - Street 2:29 CALLE 3
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754
Mailing Address - Country:US
Mailing Address - Phone:787-398-2868
Mailing Address - Fax:787-736-4555
Practice Address - Street 1:201 JOSE DE DIEGO AVE. PLAZA ANGORA
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-736-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3549103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical