Healthcare Provider Details

I. General information

NPI: 1144156019
Provider Name (Legal Business Name): STEPHANIE MARIE ACEVEDO RODRIGUEZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. FLAMBOYAN CALLE MCKINLEY D15 EDIFICIO OHARRIZ SUITE 5
CAMUY PR
00627-9460
US

IV. Provider business mailing address

HC 5 BOX 25692
CAMUY PR
00627-9460
US

V. Phone/Fax

Practice location:
  • Phone: 787-208-8400
  • Fax:
Mailing address:
  • Phone: 787-201-3727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number005753
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: