Provider Demographics
NPI:1225627292
Name:TIRADO-CLASS, DEBORAH GRACE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:GRACE
Last Name:TIRADO-CLASS
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:URB. VISTA DEL MORRO
Mailing Address - Street 2:B9 CALLE PITIRRE
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00962-4519
Mailing Address - Country:US
Mailing Address - Phone:787-484-3335
Mailing Address - Fax:
Practice Address - Street 1:173 CALLE LOS ANDES
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5435
Practice Address - Country:US
Practice Address - Phone:787-946-9995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6146103TB0200X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral