Stephanie Odalys Carrillo Nieves, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6749 Issued in PR

Practice address

Edificio Arecibo Medical Plaza
Ave. Jose Celso Barbosa #65, Suite 103
Arecibo, PR 00612-0061

Phone

(787) 562-5757

NPI assigned

Nov 21, 2022

Last updated

Nov 29, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Stephanie Odalys Carrillo Nieves Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1668988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701216000000",
    "number": "1235848060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "URB. LOS PINOS I",
            "address_2": "CALLE PINO MARITIMO #306",
            "city": "ARECIBO",
            "state": "PR",
            "postal_code": "00612",
            "telephone_number": "787-562-5757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "EDIFICIO ARECIBO MEDICAL PLAZA",
            "address_2": "AVE. JOSE CELSO BARBOSA #65, SUITE 103",
            "city": "ARECIBO",
            "state": "PR",
            "postal_code": "006120061",
            "telephone_number": "787-562-5757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRILLO NIEVES",
        "first_name": "STEPHANIE",
        "middle_name": "ODALYS",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-11-21",
        "last_updated": "2023-11-29",
        "certification_date": "2022-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PR",
            "license": "6749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Inmediata",
            "affiliation": "N",
            "endpointDescription": "Programa de facturacion medica basada en la nube que permite ingresar datos y gestionar facturacion de una forma segura.",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "contentOtherDescription": "Informacion estrictamente dirigida al paciente correspondiente",
            "address_1": "Edificio Arecibo Medical Plaza",
            "address_2": "Ave. Jose Celso Barbosa #65, Suite 103",
            "city": "Arecibo",
            "state": "PR",
            "country_code": "US",
            "postal_code": "006120061",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "CARRILLO NIEVES",
            "middle_name": "ODALYS",
            "prefix": "DR.",
            "credential": "PSY.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Jetzabel Carrion

• Clinical Psychologist in Arecibo, PR
• Providers in Arecibo, PR by specialty
• Clinical Psychologist in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.