Provider Demographics
NPI:1548075930
Name:ACOSTA LEON, ANA LUCIA (MS)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:LUCIA
Last Name:ACOSTA LEON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 CALLE GORRION
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-6503
Mailing Address - Country:US
Mailing Address - Phone:787-501-4044
Mailing Address - Fax:
Practice Address - Street 1:1605 AVE PONCE DE LEON STE 100
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1895
Practice Address - Country:US
Practice Address - Phone:787-501-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8088103TC1900X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist