Provider Demographics
NPI:1952888117
Name:BARBOSA, JOANNA L (PSYD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:L
Last Name:BARBOSA
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 427
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0427
Mailing Address - Country:US
Mailing Address - Phone:787-367-6087
Mailing Address - Fax:
Practice Address - Street 1:F15 CALLE DELFIN
Practice Address - Street 2:URB ALTURAS DE PUERTO REAL
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-367-6087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6023103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical