Provider Demographics
NPI:1972230969
Name:AGUILA-CINTRON, JIVELISSE (PH D)
Entity type:Individual
Prefix:
First Name:JIVELISSE
Middle Name:
Last Name:AGUILA-CINTRON
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 MCCLAIN DR
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-7565
Mailing Address - Country:US
Mailing Address - Phone:334-221-3994
Mailing Address - Fax:
Practice Address - Street 1:1214 MCCLAIN DR
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7565
Practice Address - Country:US
Practice Address - Phone:334-293-2270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7307103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical