Provider Demographics
NPI:1093053266
Name:CASTANEDA, JACQUELINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:CASTANEDA
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:L'ANTIGUA LB-18 VIA MALLORCA ENCANTADA
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6101
Mailing Address - Country:US
Mailing Address - Phone:787-397-3223
Mailing Address - Fax:
Practice Address - Street 1:139 -10 CALLE 401
Practice Address - Street 2:VILLA CAROLINA 4TA EXTENSION
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-4014
Practice Address - Country:US
Practice Address - Phone:787-397-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4606103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical