Provider Demographics
NPI:1386366631
Name:MOJENA RODRIGUEZ, STEPHANIE (PSYD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MOJENA RODRIGUEZ
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 1:1225 AVE PONCE DE LEON
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3907
Mailing Address - Country:US
Mailing Address - Phone:787-366-8008
Mailing Address - Fax:
Practice Address - Street 1:1225 AVE PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-3907
Practice Address - Country:US
Practice Address - Phone:939-545-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7766103TC0700X
TX39236103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical