Provider Demographics
NPI:1700052875
Name:NEGRON, IVELISSE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:IVELISSE
Middle Name:
Last Name:NEGRON
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 1:200 AVE RAFAEL CORDERO
Mailing Address - Street 2:STE. 140 PMB 103
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3740
Mailing Address - Country:US
Mailing Address - Phone:787-743-0709
Mailing Address - Fax:787-745-2992
Practice Address - Street 1:200 AVE RAFAEL CORDERO
Practice Address - Street 2:STE. 140 PMB 103
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3740
Practice Address - Country:US
Practice Address - Phone:787-743-0709
Practice Address - Fax:787-745-2992
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2770103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical