Provider Demographics
NPI:1225355324
Name:QUEVEDO PEREZ, CYNTHIA CAROLINA (MA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:CAROLINA
Last Name:QUEVEDO PEREZ
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 1:1482 AVE. F. ROOSEVELT
Mailing Address - Street 2:APARTAMENTO 511
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920
Mailing Address - Country:US
Mailing Address - Phone:787-528-9340
Mailing Address - Fax:
Practice Address - Street 1:421 CALLE SAN JOVINO
Practice Address - Street 2:URB. SAGRADO CORAZON
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4212
Practice Address - Country:US
Practice Address - Phone:787-747-1374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3636103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist