Provider Demographics
NPI:1831666080
Name:ERISMANN-DUBOCQ, ASTRID (PHD)
Entity Type:Individual
Prefix:
First Name:ASTRID
Middle Name:
Last Name:ERISMANN-DUBOCQ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3681
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-3681
Mailing Address - Country:US
Mailing Address - Phone:787-664-1074
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL MENONITA CIMA
Practice Address - Street 2:PLAZA CAYEY MONTELLANOS
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-3801
Practice Address - Country:US
Practice Address - Phone:787-664-1074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6051103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical