Provider Demographics
NPI:1407256522
Name:SEDA, GRETCHEN I (PHD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:I
Last Name:SEDA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 CALLE HONDURAS
Mailing Address - Street 2:APT 8-A CONDOMINIO EL DUERO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-2830
Mailing Address - Country:US
Mailing Address - Phone:787-378-9139
Mailing Address - Fax:
Practice Address - Street 1:265 CALLE HONDURAS
Practice Address - Street 2:APT 8-A CONDOMINIO EL DUERO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-2810
Practice Address - Country:US
Practice Address - Phone:787-378-9139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2699103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist