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General NPI Number Information
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NPI Number | 1386366631
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Entity Type | Individual
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Provider Name | STEPHANIE MOJENA RODRIGUEZ PSYD
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Gender | Female
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 1225 AVE PONCE DE LEON
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City | SAN JUAN
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State | PR
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Zip | 00907-3907
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Country | US
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Telephone | 939-545-8880
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Fax |
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Provider Business Mailing Address
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Address Line | 1225 AVE PONCE DE LEON
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City | SAN JUAN
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State | PR
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Zip | 00907-3907
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Country | US
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Telephone | 787-366-8008
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 7766
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 39236
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License Number State | TX
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