Provider Demographics
NPI:1588690531
Name:CUBANO, MARIELA A (PSYD)
Entity type:Individual
Prefix:MS
First Name:MARIELA
Middle Name:A
Last Name:CUBANO
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 JARDIN DORADO
Mailing Address - Street 2:21287 CALLE ROSA
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-7049
Mailing Address - Country:US
Mailing Address - Phone:787-621-6281
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO PUERTA DEL NORTE MALL 22 SUITE 7
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4999
Practice Address - Country:US
Practice Address - Phone:787-621-6281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2394103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2394OtherLICENCE