Provider Demographics
NPI:1164933248
Name:DAVILA-RODRIGUEZ, JOAN ENID (MA)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:ENID
Last Name:DAVILA-RODRIGUEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FLORIMAR GARDENS
Mailing Address - Street 2:J CALLE RONDA APT J103
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-923-8654
Mailing Address - Fax:
Practice Address - Street 1:1878 CALLE FRANCISCO QUINDOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7734
Practice Address - Country:US
Practice Address - Phone:787-923-8654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6346103T00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist