Provider Demographics
NPI:1487908042
Name:QUINTERO, JESSICA (MA, PSYD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:QUINTERO
Suffix:
Gender:F
Credentials:MA, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 VIA CAFETAL
Mailing Address - Street 2:HACIENDA SAN JOSE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3034
Mailing Address - Country:US
Mailing Address - Phone:787-642-5538
Mailing Address - Fax:
Practice Address - Street 1:CALLE B, # 13 (ALTOS)
Practice Address - Street 2:LA ANTILLANA
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-642-5538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003802103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical