Provider Demographics
NPI:1407314354
Name:PURCELL, WALDEMAR MANUEL (PHD, CT)
Entity Type:Individual
Prefix:DR
First Name:WALDEMAR
Middle Name:MANUEL
Last Name:PURCELL
Suffix:
Gender:M
Credentials:PHD, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DD10 CALLE GARDENIA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6312
Mailing Address - Country:US
Mailing Address - Phone:787-319-7607
Mailing Address - Fax:
Practice Address - Street 1:500 AVE MUNOZ RIVERA
Practice Address - Street 2:EL CENTRO 1 SUITE 607
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-764-8586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR283103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical