Provider Demographics
NPI:1487797007
Name:SOTO, CARMEN (PHD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 645 BOX 6387
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-9746
Mailing Address - Country:US
Mailing Address - Phone:787-292-0205
Mailing Address - Fax:787-292-0205
Practice Address - Street 1:200 AVE CUPEY GDNS
Practice Address - Street 2:PLAZA CUPEY GARDENS, SECTOR #3
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7341
Practice Address - Country:US
Practice Address - Phone:787-292-0205
Practice Address - Fax:787-292-0205
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2369103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR04553OtherPSYCHOLOGIST
PRA861OtherPSYCHOLOGIST
PR1739OtherPSHYCHOLOGIST