Provider Demographics
NPI:1841914017
Name:CONCEPCION, JUAN VICTOR (PSYD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:VICTOR
Last Name:CONCEPCION
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975B CALLE JADE
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-2603
Mailing Address - Country:US
Mailing Address - Phone:787-593-5185
Mailing Address - Fax:
Practice Address - Street 1:975B CALLE JADE
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-2603
Practice Address - Country:US
Practice Address - Phone:787-593-5185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7332103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7332Medicaid