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General NPI Number Information
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NPI Number | 1457571085
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Entity Type | Individual
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Provider Name | NICELIA RAQUEL PENA PSYD
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Gender | Female
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | FLAMBOYAN 237
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City | LAJAS
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State | PR
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Zip | 00667
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Country | US
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Telephone | 787-809-1835
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Fax | 787-899-5141
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Provider Business Mailing Address
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Address Line | SO23 CALLE LIMA VALLE HERMOSO
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City | HORMIGUEROS
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State | PR
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Zip | 00660-1230
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Country | US
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Telephone | 787-452-3612
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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 | 2496
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License Number State | PR
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