Provider Demographics
NPI:1790334738
Name:MONTALVO MENDEZ, DEBORAH (PSYD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MONTALVO MENDEZ
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 6 BOX 61431
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9817
Mailing Address - Country:US
Mailing Address - Phone:787-951-2955
Mailing Address - Fax:
Practice Address - Street 1:AVE. LOS CORAZONES, CARR. #2, KM. 127.2 INT.
Practice Address - Street 2:BO. CAIMITAL BAJO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-951-2955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005833103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical