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General NPI Number Information
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NPI Number | 1669753851
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Entity Type | Individual
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Provider Name | JANICE DE JESUS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/01/2011
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | CARR. 152 KM 11.5 BO. CEDRO ARRIBA
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City | NARANJITO
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State | PR
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Zip | 00719
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Country | US
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Telephone | 787-869-0260
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Fax | 888-846-2952
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Provider Business Mailing Address
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Address Line | PO BOX 2965
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City | CAROLINA
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State | PR
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Zip | 00984-2965
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Country | US
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Telephone | 787-406-3501
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Fax | 888-846-2952
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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 | 3866
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License Number State | PR
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