Provider Demographics
NPI:1003563479
Name:VICENTE, ZULAY YESENIA (LCDA)
Entity Type:Individual
Prefix:MISS
First Name:ZULAY
Middle Name:YESENIA
Last Name:VICENTE
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:MISS
Other - First Name:ZULAY
Other - Middle Name:YESENIA
Other - Last Name:VICENTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCDA
Mailing Address - Street 1:397 CALLE ANDRADES
Mailing Address - Street 2:
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00962-5060
Mailing Address - Country:US
Mailing Address - Phone:787-446-4045
Mailing Address - Fax:
Practice Address - Street 1:397 CALLE ANDRADES
Practice Address - Street 2:
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-5060
Practice Address - Country:US
Practice Address - Phone:787-446-4045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7296103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist