Provider Demographics
NPI:1053861153
Name:MOLINA-MAYSONET, AMARILLIS (MA PSIC)
Entity type:Individual
Prefix:
First Name:AMARILLIS
Middle Name:
Last Name:MOLINA-MAYSONET
Suffix:
Gender:F
Credentials:MA PSIC
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 1607
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-1607
Mailing Address - Country:US
Mailing Address - Phone:787-412-5923
Mailing Address - Fax:
Practice Address - Street 1:CARR. 140 KM64 H2
Practice Address - Street 2:CRUCE DAVILA
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617
Practice Address - Country:US
Practice Address - Phone:787-412-5923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4706103TS0200X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health