Provider Demographics
NPI:1720311103
Name:ALVARADO MARRERO, JESSELYN (PSYD)
Entity type:Individual
Prefix:MISS
First Name:JESSELYN
Middle Name:
Last Name:ALVARADO MARRERO
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:CARRETERA 702 BUZON #23
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769
Mailing Address - Country:US
Mailing Address - Phone:787-317-4155
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 149 KM 58.0
Practice Address - Street 2:ED. SAN GERALDO SUITE 207G
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-847-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2017-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3185103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist