Provider Demographics
NPI:1164998191
Name:MAESTRE GOMEZ, ESTEFANIA (MHS, PSYD)
Entity Type:Individual
Prefix:MISS
First Name:ESTEFANIA
Middle Name:
Last Name:MAESTRE GOMEZ
Suffix:
Gender:F
Credentials:MHS, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 AVE DEL VALLE
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3901
Mailing Address - Country:US
Mailing Address - Phone:787-503-8889
Mailing Address - Fax:
Practice Address - Street 1:1808 AVE DEL VALLE
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3901
Practice Address - Country:US
Practice Address - Phone:787-503-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7707103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical