Provider Demographics
NPI:1194346213
Name:RODRIGUEZ ALICEA, VIVIAN I (PSYD)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:I
Last Name:RODRIGUEZ ALICEA
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 1:329 CALLE PASEO DEL PARQUE
Mailing Address - Street 2:URB. EL VALLE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-415-3927
Mailing Address - Fax:
Practice Address - Street 1:L 14 C METRO PLAZA CAGUAS
Practice Address - Street 2:AVENIDA JOSE GARRIDO VILLA BLANCA PARK
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-415-3927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005720103T00000X, 103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling