Provider Demographics
NPI:1629410956
Name:MIRANDES, MARIA WALESKA (PSY D)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:WALESKA
Last Name:MIRANDES
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE PACIFICO K-128
Mailing Address - Street 2:UR.B. PALACIOS DEL PRADO
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795
Mailing Address - Country:US
Mailing Address - Phone:787-365-5543
Mailing Address - Fax:
Practice Address - Street 1:CALLE PACIFICO K-128
Practice Address - Street 2:UR.B. PALACIOS DEL PRADO
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-365-5543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4020103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical