Provider Demographics
NPI:1376823245
Name:MAYOL-ALICEA, GLENDA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GLENDA
Middle Name:
Last Name:MAYOL-ALICEA
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:HC 7 BOX 30051
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-9733
Mailing Address - Country:US
Mailing Address - Phone:787-244-3473
Mailing Address - Fax:
Practice Address - Street 1:HC 7 BOX 30051
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-9733
Practice Address - Country:US
Practice Address - Phone:787-244-3473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4016103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist