Provider Demographics
NPI:1194292870
Name:VINCENTY, ALIDA ANGEOLINA (MA)
Entity type:Individual
Prefix:
First Name:ALIDA
Middle Name:ANGEOLINA
Last Name:VINCENTY
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:PROFFESIONAL BUILDING PLAZA
Mailing Address - Street 2:770 AVE HOSTOS 302A
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-407-1490
Mailing Address - Fax:
Practice Address - Street 1:770 AVE HOSTOS STE 302
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1552
Practice Address - Country:US
Practice Address - Phone:787-407-1490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000888101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor