Provider Demographics
NPI:1386367233
Name:LARACUENTE NEGRON, CANDIE MARIE (PHD)
Entity type:Individual
Prefix:MRS
First Name:CANDIE
Middle Name:MARIE
Last Name:LARACUENTE NEGRON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CANDIE
Other - Middle Name:MARIE
Other - Last Name:LARACUENTE NEGRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2749 CALLE PALMA DE LLUVIA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-1992
Mailing Address - Country:US
Mailing Address - Phone:873-680-2417
Mailing Address - Fax:
Practice Address - Street 1:55E CALLE SALMON
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-8112
Practice Address - Country:US
Practice Address - Phone:939-413-8792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical