Provider Demographics
NPI:1417797861
Name:SERRANO, HERIMAR (CPL)
Entity type:Individual
Prefix:
First Name:HERIMAR
Middle Name:
Last Name:SERRANO
Suffix:
Gender:F
Credentials:CPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 CALLE ARGENTINA
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-2309
Mailing Address - Country:US
Mailing Address - Phone:787-923-5689
Mailing Address - Fax:
Practice Address - Street 1:AA14 CALLE 13 URB. ALTURAS DE RIO GRANDE
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-887-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4559101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health