Provider Demographics
NPI:1447912506
Name:MARRERO, JOMARY (LPC)
Entity type:Individual
Prefix:
First Name:JOMARY
Middle Name:
Last Name:MARRERO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JOMARY
Other - Middle Name:
Other - Last Name:MARRERO MIRANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:CORDOBA PARK 400
Mailing Address - Street 2:BO TORTUGO APT 70
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-344-1471
Mailing Address - Fax:
Practice Address - Street 1:CORDOBA PARK 400
Practice Address - Street 2:BO TORTUGO APT 70
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-344-1471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4294101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty