Healthcare Provider Details

I. General information

NPI: 1356269369
Provider Name (Legal Business Name): STEPHANIE MARIE VIERA SISCO M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4972 AVE MILITAR
ISABELA PR
00662-4163
US

IV. Provider business mailing address

PO BOX 1674
HATILLO PR
00659-8674
US

V. Phone/Fax

Practice location:
  • Phone: 787-365-0465
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number9228
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: