Provider Demographics
NPI:1518273739
Name:OCASIO, IVONNE (PHD)
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:
Last Name:OCASIO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W WILLIAM CANNON DR
Mailing Address - Street 2:SUITE 703
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5257
Mailing Address - Country:US
Mailing Address - Phone:512-494-4162
Mailing Address - Fax:518-751-9514
Practice Address - Street 1:2500 W WILLIAM CANNON DR
Practice Address - Street 2:SUITE 703
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5257
Practice Address - Country:US
Practice Address - Phone:512-494-4162
Practice Address - Fax:518-751-9514
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36478103TC0700X
PR2494103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3289878-01Medicaid
TX3289878-01Medicaid