Provider Demographics
NPI:1093932899
Name:DE JESUS, MARGARITA R (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARGARITA
Middle Name:R
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:AVE CAMPO BELLO
Mailing Address - Street 2:PO BOX 1328
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737
Mailing Address - Country:US
Mailing Address - Phone:787-738-0529
Mailing Address - Fax:
Practice Address - Street 1:JOSE DE DIEGO # 392 OESTE
Practice Address - Street 2:APARTADO 372770
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00737-2770
Practice Address - Country:US
Practice Address - Phone:787-738-4114
Practice Address - Fax:787-738-2149
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1385103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical