Provider Demographics
NPI:1104599711
Name:ARISTUD, GRETCHEN M (MA)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:M
Last Name:ARISTUD
Suffix:
Gender:F
Credentials:MA
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 9809
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CENTRO COMERCIAL HUMACAO 10 A AVE. FONT MARTELO
Practice Address - Street 2:LOCAL 3 Y 4
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00972
Practice Address - Country:US
Practice Address - Phone:787-704-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling