Provider Demographics
NPI:1497907158
Name:GINEBRA, VANESSA MARGARITA (MA)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:MARGARITA
Last Name:GINEBRA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1950
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1950
Mailing Address - Country:US
Mailing Address - Phone:787-439-5393
Mailing Address - Fax:
Practice Address - Street 1:160A CARR 459
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-6263
Practice Address - Country:US
Practice Address - Phone:787-439-5393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2064103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist