Provider Demographics
NPI:1548600034
Name:CEPEDA, NADINE TAIJERON (MA)
Entity Type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:TAIJERON
Last Name:CEPEDA
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 1:414 W SOLEDAD AVE
Mailing Address - Street 2:SUITE 702
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96910-5061
Mailing Address - Country:US
Mailing Address - Phone:671-483-1017
Mailing Address - Fax:671-477-1077
Practice Address - Street 1:414 W SOLEDAD AVE
Practice Address - Street 2:SUITE 702
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910-5061
Practice Address - Country:US
Practice Address - Phone:671-483-1017
Practice Address - Fax:671-477-1077
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUIMF-105106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist