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General NPI Number Information
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NPI Number | 1427837954
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Entity Type | Individual
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Provider Name | VIVIANA BEATRIZ VICENS-AXTMAYER M.A.
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Gender | Female
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | CALLE 13 NE #346 ALTOS
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City | SAN JUAN
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State | PR
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Zip | 00920
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Country | US
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Telephone | 939-625-1356
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Fax |
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Provider Business Mailing Address
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Address Line | APT 12 J 1 CALLE HORTENSIA
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City | SAN JUAN
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State | PR
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Zip | 00926-6545
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Country | US
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Telephone | 787-649-3629
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6309
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License Number State | PR
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