Provider Demographics
NPI:1437368883
Name:SEPULVEDA, CARMEN I (PSYD)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:I
Last Name:SEPULVEDA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:URB MANSIONES DEL CARIBE 190 AQUAMARINA
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-5219
Mailing Address - Country:US
Mailing Address - Phone:787-381-6613
Mailing Address - Fax:787-893-5010
Practice Address - Street 1:CALLE DUFRESNE #19
Practice Address - Street 2:SUITE 1
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-5219
Practice Address - Country:US
Practice Address - Phone:787-381-6613
Practice Address - Fax:787-893-5010
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2150103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical