Provider Demographics
NPI:1700826773
Name:LEDESMA, DAMARIS (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:DAMARIS
Middle Name:
Last Name:LEDESMA
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 1:15 FRANCISCO FRANCESHI BY
Mailing Address - Street 2:LEVITOWN LAKES
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-8574
Mailing Address - Country:US
Mailing Address - Phone:787-415-2525
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO JUAN BURGOS CARS 2 KM 45 HM 2 BO CANTERAS
Practice Address - Street 2:APS CLINICS OF PUERTO RICO INC MANATI
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-641-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1444103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR25063861OtherSTATE LICENSE