Provider Demographics
NPI:1265692941
Name:ACEVEDO CRUZ, LISSETTE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LISSETTE
Middle Name:
Last Name:ACEVEDO CRUZ
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:PO BOX 4449
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-4449
Mailing Address - Country:US
Mailing Address - Phone:787-690-8778
Mailing Address - Fax:
Practice Address - Street 1:CARR 107 # KM 2/5
Practice Address - Street 2:PLAZA SOLA DEL LLANO SUITE 4
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5970
Practice Address - Country:US
Practice Address - Phone:787-690-8778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2227103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical