Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6619 | PR |
Y | 103TC0700X | Clinical Psychologist | 6619 | PR |
N | 1041C0700X | Clinical Social Worker | 10466 | PR |
NPI | 1003150301 |
---|---|
Provider Name | Glenda L. Bravo Otero |
First Address | Aguadilla, PR 00690 |
Second Address | Aguadilla, PR 00690 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2012 |
Last Update Date | 22/09/2020 |