Provider Demographics
NPI:1538353370
Name:CABIYA, IVELISSE D (MAESTRIA)
Entity type:Individual
Prefix:MRS
First Name:IVELISSE
Middle Name:D
Last Name:CABIYA
Suffix:
Gender:F
Credentials:MAESTRIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JOSE DE DIEGO #6
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638
Mailing Address - Country:US
Mailing Address - Phone:787-871-0356
Mailing Address - Fax:787-871-2211
Practice Address - Street 1:JOSE DE DIEGO #6
Practice Address - Street 2:
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638
Practice Address - Country:US
Practice Address - Phone:787-871-0356
Practice Address - Fax:787-871-2211
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR663103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical