Provider Demographics
NPI:1871703579
Name:BERRIOS, MARISOL (MS, CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:MARISOL
Middle Name:
Last Name:BERRIOS
Suffix:
Gender:F
Credentials:MS, CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 5100
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-9743
Mailing Address - Country:US
Mailing Address - Phone:787-616-5466
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL PEDRIATICO UNIVERSITARIO DR ANTONIO ORTIZ
Practice Address - Street 2:TERAPIA DEL HABLA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919-1079
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR543235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist