Provider Demographics
NPI:1003134925
Name:ENRIQUEZ, YANIA IVELISSE (M PSY)
Entity Type:Individual
Prefix:
First Name:YANIA
Middle Name:IVELISSE
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:M PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 CALLE SANTIAGO PALMER N
Mailing Address - Street 2:43 NORTE
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784-4967
Mailing Address - Country:US
Mailing Address - Phone:787-318-2504
Mailing Address - Fax:787-864-4362
Practice Address - Street 1:43 CALLE SANTIAGO PALMER N
Practice Address - Street 2:43 NORTE
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-4967
Practice Address - Country:US
Practice Address - Phone:787-318-2504
Practice Address - Fax:787-864-4362
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist