Individual
ILEANA S. FASICK FUMERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSCP
Contact information
Practice address
1704 CALLE PARANA, SAN JUAN, PR 00926-3160
(787) 300-1015
Mailing address
100 CALLE PRINCIPE GUILLERMO, GUAYNABO, PR 00969-5332
(787) 300-1015
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
7693
PR
Other
Enumeration date
08/08/2023
Last updated
08/08/2023
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