Provider Demographics
NPI:1306098504
Name:ALICEA, IVAN RAUL (PSICOLOGO)
Entity type:Individual
Prefix:DR
First Name:IVAN
Middle Name:RAUL
Last Name:ALICEA
Suffix:
Gender:M
Credentials:PSICOLOGO
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Other - Credentials:
Mailing Address - Street 1:QUINTAS DE CABO ROJO #168
Mailing Address - Street 2:CALLE CISNE
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-254-0277
Mailing Address - Fax:787-831-3714
Practice Address - Street 1:CENTRO SALUD MENTAL DE MAYAGUEZ
Practice Address - Street 2:410 AVE HOSTOS SUITE 7
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1522
Practice Address - Country:US
Practice Address - Phone:787-831-3714
Practice Address - Fax:787-831-3714
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR2517103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical