Provider Demographics
NPI:1588891345
Name:CARRION LUNA, MELISA
Entity type:Individual
Prefix:MRS
First Name:MELISA
Middle Name:
Last Name:CARRION LUNA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MELISA
Other - Middle Name:
Other - Last Name:CARRION LUNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:HC 02 BOX 13211
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVE. GAUTIER BENITEZ LOCAL B5 CONSOLIDATED MALL
Practice Address - Street 2:INSTITUTO PSICOTERAPEUTICO DE PR
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-704-0705
Practice Address - Fax:787-744-7444
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2534103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling