Provider Demographics
NPI:1972743201
Name:BERRIOS, JESUS (MA)
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:
Last Name:BERRIOS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 75 BOX 1775
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-9731
Mailing Address - Country:US
Mailing Address - Phone:787-365-7268
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 780 BARRIO DONA ELENA
Practice Address - Street 2:
Practice Address - City:COMERIO
Practice Address - State:PR
Practice Address - Zip Code:00782
Practice Address - Country:US
Practice Address - Phone:787-365-7268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3325103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist