Provider Demographics
NPI:1831631019
Name:CENTENO, YESICA
Entity type:Individual
Prefix:
First Name:YESICA
Middle Name:
Last Name:CENTENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PLAZA DEGETAU 1
Mailing Address - Street 2:CALLE SHUFFORD SUITE 109 PMB 202
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-4977
Mailing Address - Country:US
Mailing Address - Phone:787-341-6082
Mailing Address - Fax:
Practice Address - Street 1:URB. BONNEVILLE HEIGHTS
Practice Address - Street 2:CALLE AIBONITO 60
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-4977
Practice Address - Country:US
Practice Address - Phone:939-395-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-05
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5408103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling