Provider Demographics
NPI:1376848234
Name:CENTENO, JUAN CARLOS (MSPSY)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:CENTENO
Suffix:
Gender:M
Credentials:MSPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 AVE FD ROOSEVELT
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1137
Mailing Address - Country:US
Mailing Address - Phone:787-605-9972
Mailing Address - Fax:
Practice Address - Street 1:AVE. ROOSVELT 601
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-8166
Practice Address - Country:US
Practice Address - Phone:787-605-9972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3512103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist