Provider Demographics
NPI:1699491423
Name:RABELL-BERRIOS, ELBA (MA)
Entity type:Individual
Prefix:
First Name:ELBA
Middle Name:
Last Name:RABELL-BERRIOS
Suffix:
Gender:F
Credentials:MA
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 381
Mailing Address - Street 2:CALLE ROSA
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-360-0052
Mailing Address - Fax:
Practice Address - Street 1:AVE PONCE DE LEON 1607
Practice Address - Street 2:SUITE 308 COBIAN PLAZA
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-360-0052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7416103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7416OtherPSICOLOGY LICENSE