Provider Demographics
NPI:1376837575
Name:MELENDEZ VALLE, ADELITZA
Entity Type:Individual
Prefix:
First Name:ADELITZA
Middle Name:
Last Name:MELENDEZ VALLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 ESTANCIAS DE IMBERY
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-9715
Mailing Address - Country:US
Mailing Address - Phone:787-528-2079
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO PLAZA JARDINES SUITE 5
Practice Address - Street 2:CARR NUM 2 KM 41.6
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-528-2079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3472103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist