Provider Demographics
NPI:1841733037
Name:BRACERO, YAMID (PSYD)
Entity type:Individual
Prefix:
First Name:YAMID
Middle Name:
Last Name:BRACERO
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 1:30 CALLE JUAN C. BORBON
Mailing Address - Street 2:CONDOMINIO PARQUE REAL APT 220
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-644-4284
Mailing Address - Fax:
Practice Address - Street 1:30 CALLE JUAN C. BORBON
Practice Address - Street 2:CONDOMINIO PARQUE REAL APT 220
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-644-4284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2233103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical