MEDICARE: DR. GLENDA MAYOL-ALICEA PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	4016	PR

General Provider Information

NPI Number	:	1376823245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENDA MAYOL-ALICEA PSYD

Provider Business Mailing Address
First Line	:	HC 7 BOX 30051
Second Line	:
City	:	JUANA DIAZ
State	:	PR
Zip	:	00795-9733
Country	:	US
Telephone Number	:	787-244-3473
Fax Number	:

Provider Business Practice Location Address
First Line	:	HC 7 BOX 30051
Second Line	:
City	:	JUANA DIAZ
State	:	PR
Zip	:	00795-9733
Country	:	US
Telephone Number	:	787-244-3473
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2011
Last Update Date	:	08/17/2016

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