Provider Demographics
NPI:1851577464
Name:DE JESUS, SOCRAYDA E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SOCRAYDA
Middle Name:E
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SOCRAYDA
Other - Middle Name:E
Other - Last Name:DE JESUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:URB ALAMEIN
Mailing Address - Street 2:13 LEPANTO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-632-6794
Mailing Address - Fax:
Practice Address - Street 1:URB ALAMEIN
Practice Address - Street 2:LEPANTO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3214
Practice Address - Country:US
Practice Address - Phone:787-632-6794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2642103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling