Provider Demographics
NPI:1811965452
Name:CARRION, IVIS S (PSYD)
Entity type:Individual
Prefix:DR
First Name:IVIS
Middle Name:S
Last Name:CARRION
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:#107 ABERDEEN ST
Mailing Address - Street 2:COLLEGEVILLE
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-448-7106
Mailing Address - Fax:
Practice Address - Street 1:AVE LAUREL #300 PLAZA LAUREL
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-288-0277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2103103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1811965452OtherMEDICAL CARD SYSTEM
PR1811965452OtherFHC
PR1969OtherAPS HEALTHCARE
PR56705OtherTRIPLE S, INC
PR1969OtherHUMANA HEALTH SYSTEMS
PR1811965452OtherMMM
PR1811965452OtherCOSVI
PR1811965452OtherMAPFRE
PR550203OtherFHC