Provider Demographics
NPI:1265673602
Name:IRIZARRY FELICIANO, MAYTE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MAYTE
Middle Name:
Last Name:IRIZARRY FELICIANO
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 1:9 ST
Mailing Address - Street 2:SUITE NUMBER 32
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-4800
Mailing Address - Country:US
Mailing Address - Phone:787-858-4333
Mailing Address - Fax:
Practice Address - Street 1:CALLE ENSANCHE SILVA #59
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-858-4388
Practice Address - Fax:787-858-4333
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PR3570103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health