Provider Demographics
NPI:1841767860
Name:ROMAN-MARRERO, ANNETTE D (PHD, MS)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:D
Last Name:ROMAN-MARRERO
Suffix:
Gender:F
Credentials:PHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 CALLE CUEVAS BUSTAMANTE
Mailing Address - Street 2:PARQ CENTRAL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2642
Mailing Address - Country:US
Mailing Address - Phone:787-614-9285
Mailing Address - Fax:
Practice Address - Street 1:CALLE S CUEVAS BUSTAMANTE, URB. PARQ. CENTRAL
Practice Address - Street 2:525
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2642
Practice Address - Country:US
Practice Address - Phone:787-614-9285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7617103T00000X, 103TF0000X, 103TC0700X, 103T00000X
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7617OtherPSYCHOLOGY
PR1396147724Medicaid