Provider Demographics
NPI:1508153693
Name:CONESA, ALICIA R (MA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:R
Last Name:CONESA
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:VALLE SANTA CECILIA
Mailing Address - Street 2:EDIF. 7 APT.102
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3004
Mailing Address - Country:US
Mailing Address - Phone:939-579-5364
Mailing Address - Fax:787-259-1272
Practice Address - Street 1:URB. VILLA CRIOLLO
Practice Address - Street 2:A 9
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-746-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3859103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling