Healthcare Provider Details

I. General information

NPI: 1831133305
Provider Name (Legal Business Name): RAFAEL E CANCIO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA VA CARIBBEAN HEALTHCARE SYSTEM (116B)
SAN JUAN PR
00921-3200
US

IV. Provider business mailing address

10 CALLE CASIA VA CARIBBEAN HEALTHCARE SYSTEM (116B)
SAN JUAN PR
00921-3200
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax:
Mailing address:
  • Phone: 787-641-7582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number1984
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number1984
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1984
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1984
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number1984
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1984
License Number StatePR
# 7
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1984
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: