Provider Demographics
NPI:1073264776
Name:FONTANEZ, JESSENIA MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSENIA
Middle Name:MARIE
Last Name:FONTANEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 4952
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-9644
Mailing Address - Country:US
Mailing Address - Phone:956-410-4985
Mailing Address - Fax:
Practice Address - Street 1:2106 TREASURE HILLS BLVD APT 1107
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8736
Practice Address - Country:US
Practice Address - Phone:956-410-4985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR007157103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty