Provider Demographics
NPI:1861721680
Name:CRUZ SEDA, MA, PH.D.C, JORGE ALBERTO (1991)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ALBERTO
Last Name:CRUZ SEDA, MA, PH.D.C
Suffix:
Gender:M
Credentials:1991
Other - Prefix:DR
Other - First Name:JORGE
Other - Middle Name:ALBERTO
Other - Last Name:CRUZ SEDA, MA, PH.D.C
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYCHOLOGIST
Mailing Address - Street 1:PO BOX 1553
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-1553
Mailing Address - Country:US
Mailing Address - Phone:787-538-7557
Mailing Address - Fax:
Practice Address - Street 1:14 CALLE CRISTOBAL COLON
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-2838
Practice Address - Country:US
Practice Address - Phone:787-538-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1991103TC0700X, 103K00000X
101YM0800X, 106H00000X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR107885OtherPUERTO RICO DEPT. OF HEALTH, HEALTH SERVICES PERSONNEL REGISTER NUMBER
PR1991OtherPSYCHOLOGIST LICENSE FROM PUERTO RICO DEPT. OF HEALTH