Provider Demographics
NPI:1669753851
Name:DE JESUS, JANICE (PHD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:
Last Name:DE JESUS
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 2965
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-2965
Mailing Address - Country:US
Mailing Address - Phone:787-406-3501
Mailing Address - Fax:888-846-2952
Practice Address - Street 1:CARR. 152 KM 11.5
Practice Address - Street 2:BO. CEDRO ARRIBA
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719
Practice Address - Country:US
Practice Address - Phone:787-869-0260
Practice Address - Fax:888-846-2952
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3866103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical