Provider Demographics
NPI:1962539510
Name:BERRIOS, VANESSA (PHD)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:BERRIOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 801202
Mailing Address - Street 2:COTO LAUREL
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1202
Mailing Address - Country:US
Mailing Address - Phone:787-848-1010
Mailing Address - Fax:
Practice Address - Street 1:CENTRO CIRUGIA CARDIOVASCULAR HOSPITAL DAMAS
Practice Address - Street 2:SUITE 2DO PISO 2213 PONCE BY PASS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1318
Practice Address - Country:US
Practice Address - Phone:787-848-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1177103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical