Provider Demographics
NPI:1376727032
Name:MENENDEZ, ALICIA MARGARITA (PH D)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:MARGARITA
Last Name:MENENDEZ
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9022760
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00902-2760
Mailing Address - Country:US
Mailing Address - Phone:787-409-4158
Mailing Address - Fax:
Practice Address - Street 1:1801 AVE. PONCE DE LEON
Practice Address - Street 2:SUITE 311
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-727-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR591103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist