Provider Demographics
NPI:1477098929
Name:MELENDEZ, MARIA DEL MAR (PSYD)
Entity Type:Individual
Prefix:
First Name:MARIA DEL MAR
Middle Name:
Last Name:MELENDEZ
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:A15 CALLE TRAVIATA
Mailing Address - Street 2:URB LA ALBORADA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-644-1744
Mailing Address - Fax:
Practice Address - Street 1:A15 CALLE TRAVIATA
Practice Address - Street 2:URB LA ALBORADA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-644-1744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5745103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical