Provider Demographics
NPI:1467764928
Name:ANAVITARTE, ARACELIS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ARACELIS
Middle Name:
Last Name:ANAVITARTE
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 1:3104 AVE JULIO E MONAGAS
Mailing Address - Street 2:URB. CONSTANCIA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2200
Mailing Address - Country:US
Mailing Address - Phone:787-647-3162
Mailing Address - Fax:
Practice Address - Street 1:3104 AVE JULIO E MONAGAS
Practice Address - Street 2:URB. CONSTANCIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2200
Practice Address - Country:US
Practice Address - Phone:787-647-3162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3497103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical