Provider Demographics
NPI:1154651339
Name:CRUZ-PAGAN, MARCELLE E (PSYD)
Entity Type:Individual
Prefix:
First Name:MARCELLE
Middle Name:E
Last Name:CRUZ-PAGAN
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:B16 CALLE 2
Mailing Address - Street 2:URB BRISAS DEL MAR
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-2236
Mailing Address - Country:US
Mailing Address - Phone:787-354-2088
Mailing Address - Fax:
Practice Address - Street 1:B16 CALLE 2 URB
Practice Address - Street 2:BRISAS DEL MAR
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773-2236
Practice Address - Country:US
Practice Address - Phone:787-354-2088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3525103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical