Provider Demographics
NPI:1194266916
Name:FELICIANO MISLA, GLENDALIZ (PSYD)
Entity type:Individual
Prefix:DR
First Name:GLENDALIZ
Middle Name:
Last Name:FELICIANO MISLA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 AVE NOEL ESTRADA
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-3229
Mailing Address - Country:US
Mailing Address - Phone:787-605-2236
Mailing Address - Fax:
Practice Address - Street 1:3361 AVE MILITAR
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-4082
Practice Address - Country:US
Practice Address - Phone:787-605-2236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5794103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical