Provider Demographics
NPI:1730674128
Name:DE LEON, DENISSE (MPSY)
Entity Type:Individual
Prefix:
First Name:DENISSE
Middle Name:
Last Name:DE LEON
Suffix:
Gender:F
Credentials:MPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB CIUDAD JARDIN DE JUNCOS
Mailing Address - Street 2:447 CALLE BATEY
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777
Mailing Address - Country:US
Mailing Address - Phone:787-438-4145
Mailing Address - Fax:
Practice Address - Street 1:URB CIUDAD JARDIN DE JUNCOS
Practice Address - Street 2:447 CALLE BATEY
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:787-438-4145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6045103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist