Provider Demographics
NPI:1295286656
Name:REYES ACEVEDO, BETHZAIDA (MA)
Entity type:Individual
Prefix:MISS
First Name:BETHZAIDA
Middle Name:
Last Name:REYES ACEVEDO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6091 CALLE OASIS
Mailing Address - Street 2:SECTOR TOCONES
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662
Mailing Address - Country:US
Mailing Address - Phone:939-278-3894
Mailing Address - Fax:
Practice Address - Street 1:6091 CALLE OASIS
Practice Address - Street 2:SECTOR TOCONES
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:939-278-3894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5710103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool