Provider Demographics
NPI:1962995191
Name:MAISONET, JOSE R (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:MAISONET
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:R
Other - Last Name:MAISONET
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 2724
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-2724
Mailing Address - Country:US
Mailing Address - Phone:787-378-4051
Mailing Address - Fax:
Practice Address - Street 1:URB. RODRIGUEZ OLMO
Practice Address - Street 2:CALLE B#12
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-378-4051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PR7375103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health