Provider Demographics
NPI:1730393752
Name:SEPULVEDA, JANET MARIE (PHD)
Entity type:Individual
Prefix:MR
First Name:JANET
Middle Name:MARIE
Last Name:SEPULVEDA
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 1:501 CALLE MARIEN
Mailing Address - Street 2:COLINAS DE BAYOAN
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-3780
Mailing Address - Country:US
Mailing Address - Phone:787-279-3572
Mailing Address - Fax:
Practice Address - Street 1:7 CALLE GUARIONEX
Practice Address - Street 2:HATO REY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4431
Practice Address - Country:US
Practice Address - Phone:787-767-7695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2700103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical