Provider Demographics
NPI:1316706112
Name:CUADRADO, JESSENIA MARIE
Entity type:Individual
Prefix:MRS
First Name:JESSENIA
Middle Name:MARIE
Last Name:CUADRADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1241
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-1241
Mailing Address - Country:US
Mailing Address - Phone:787-690-0690
Mailing Address - Fax:
Practice Address - Street 1:405 AV. LIC.
Practice Address - Street 2:EUGENIO MARIA DE HOSTOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-704-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7786103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling