Healthcare Provider Details

I. General information

NPI: 1144156639
Provider Name (Legal Business Name): AVENCENEUROCOGNITIVO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CALLE CUPEY GDNS STE 11W
CUPEY PR
00926-7366
US

IV. Provider business mailing address

200 CALLE CUPEY GDNS STE 11W
CUPEY PR
00926-7366
US

V. Phone/Fax

Practice location:
  • Phone: 646-780-0899
  • Fax:
Mailing address:
  • Phone: 646-780-0899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: KAREN VALDESUSO
Title or Position: NEUROPSYCHOLOGIST
Credential: PSYD
Phone: 646-780-0899