Provider Demographics
NPI:1114059342
Name:CASTRO GUTIERREZ, GLENDA L (PSY D)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:L
Last Name:CASTRO GUTIERREZ
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JARDINES DE SAN FRANCISCO
Mailing Address - Street 2:APT 602-2
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:787-220-1791
Mailing Address - Fax:787-763-1833
Practice Address - Street 1:982 GUTENBERG
Practice Address - Street 2:JARDINES METROPOLITANOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-220-1791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2735103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical