Provider Demographics
NPI:1427756097
Name:DIAZ ROBLES, SUSAREL (MPSY)
Entity type:Individual
Prefix:
First Name:SUSAREL
Middle Name:
Last Name:DIAZ ROBLES
Suffix:
Gender:F
Credentials:MPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. MONTECASINO HEIGHTS
Mailing Address - Street 2:138 RIO SONADOR
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-688-4789
Mailing Address - Fax:
Practice Address - Street 1:URB. MONTECASINO HEIGHTS
Practice Address - Street 2:138 RIO SONADOR
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-688-4789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7530103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling