Provider Demographics
NPI:1275850257
Name:SALCEDO, MARY JO (PSY-D)
Entity Type:Individual
Prefix:DR
First Name:MARY JO
Middle Name:
Last Name:SALCEDO
Suffix:
Gender:F
Credentials:PSY-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UBR. BRISAS DE MONTECASINO
Mailing Address - Street 2:421
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-459-3605
Mailing Address - Fax:
Practice Address - Street 1:UBR. BRISAS DE MONTECASINO
Practice Address - Street 2:421
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-459-3605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3675103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical