Healthcare Provider Details

I. General information

NPI: 1982748000
Provider Name (Legal Business Name): DEBORAH L. SIEVENS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE.TITO CASTRO 931 CARR.14 BO. MACHUELO
PONCE PR
00716-4717
US

IV. Provider business mailing address

PO BOX 560852
GUAYANILLA PR
00656-3852
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-7202
  • Fax: 787-842-5809
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2151
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: