Provider Demographics
NPI:1144408527
Name:CRESPO, NADJA IVETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NADJA
Middle Name:IVETTE
Last Name:CRESPO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DD14 CALLE 215
Mailing Address - Street 2:URB VALLE ARRIBA HEIGHTS
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-3708
Mailing Address - Country:US
Mailing Address - Phone:787-647-3294
Mailing Address - Fax:
Practice Address - Street 1:BLQ 35 #21 AV SANCHEZ CASTANO
Practice Address - Street 2:URB. VILLA CAROLINA GRUPO MEDICO CAROLINA LLC
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-9998
Practice Address - Country:US
Practice Address - Phone:787-752-1979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2963103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2963OtherPSYCHOLOGIST LICENCE
PR2112567OtherDRIVER'S LICENCE