Provider Demographics
NPI:1538571500
Name:NEGRON, NANNETTE (PHD)
Entity type:Individual
Prefix:
First Name:NANNETTE
Middle Name:
Last Name:NEGRON
Suffix:
Gender:F
Credentials:PHD
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 16300
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-6300
Mailing Address - Country:US
Mailing Address - Phone:787-624-9155
Mailing Address - Fax:
Practice Address - Street 1:400 AVE DOMENECH STE 604
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3706
Practice Address - Country:US
Practice Address - Phone:787-316-5082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5505103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1538571500OtherDPI