Provider Demographics
NPI:1659706398
Name:RODRIGUEZ NIEVES, ANGELICA (PSYD)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:RODRIGUEZ NIEVES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC-3 BOX 9401
Mailing Address - Street 2:
Mailing Address - City:COMERIO
Mailing Address - State:PR
Mailing Address - Zip Code:00782
Mailing Address - Country:US
Mailing Address - Phone:939-288-4870
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 9401
Practice Address - Street 2:
Practice Address - City:COMERIO
Practice Address - State:PR
Practice Address - Zip Code:00782-9570
Practice Address - Country:US
Practice Address - Phone:939-288-4870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4669103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical