Healthcare Provider Details

I. General information

NPI: 1639013790
Provider Name (Legal Business Name): NICOLE A ANDINO CRUZ PSY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

D12 CALLE MIS AMORES
CAGUAS PR
00725-5821
US

IV. Provider business mailing address

D12 CALLE MIS AMORES
CAGUAS PR
00725-5821
US

V. Phone/Fax

Practice location:
  • Phone: 787-930-3144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number8630
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: