Healthcare Provider Details

I. General information

NPI: 1144408527
Provider Name (Legal Business Name): NADJA IVETTE CRESPO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AVE CALDERON APT 108
CAROLINA PR
00985-4910
US

IV. Provider business mailing address

DD14 CALLE 215 URB VALLE ARRIBA HEIGHTS
CAROLINA PR
00983-3708
US

V. Phone/Fax

Practice location:
  • Phone: 939-376-4999
  • Fax:
Mailing address:
  • Phone: 787-647-3294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2963
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: