Provider Demographics
NPI:1306972310
Name:ALICEA, LUISA (PSY D)
Entity type:Individual
Prefix:DR
First Name:LUISA
Middle Name:
Last Name:ALICEA
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CONDOMINIO LA ARBOLEDA
Mailing Address - Street 2:APT. 2702
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-740-7850
Mailing Address - Fax:787-740-1074
Practice Address - Street 1:URB SANTA ROSA AVE MAIN
Practice Address - Street 2:BLOQUE 43 #13
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-740-7850
Practice Address - Fax:787-740-1074
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR654103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist