Provider Demographics
NPI:1487460424
Name:CACERES CARRION, NINOSHKA (PSYD)
Entity type:Individual
Prefix:
First Name:NINOSHKA
Middle Name:
Last Name:CACERES CARRION
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:HC 3 BOX 9509
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-8630
Mailing Address - Country:US
Mailing Address - Phone:939-223-8298
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 9509
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-8630
Practice Address - Country:US
Practice Address - Phone:939-223-8298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8115103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical