Active NPI
Raquel Ivelisse Lopez Crespo, PSIC
- Psychologist
- Canovanas, PR
National Provider Identifier
1245864081
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6375
- Practice address
- Enrique Mangual Canovanas Mall
Oficina Local 14
Canovanas, PR 00729 - Phone
- (787) 344-1277
- NPI assigned
- Mar 2, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6375 | PR | Primary |
Addresses
Primary practice location
Enrique Mangual Canovanas Mall
Oficina Local 14
Canovanas, PR 00729
Mailing address
Villas de Loiza
Calle 28a TT21
Canovanas, PR 00729
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260319003970 | PR | Practitioner - Psychologist Billing Independently | 8820572589 | Practice locations: San Juan, PR |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2018
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1714 Calle Parana
San Juan, PR 00926
1714 Calle Parana
San Juan, PR 00926-3148
Phone (787) 344-1277
TT21 Calle
28A
Canovanas, PR 00729
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6375 | PR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676592000000",
"number": "1245864081",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "VILLAS DE LOIZA",
"address_2": "CALLE 28A TT21",
"city": "CANOVANAS",
"state": "PR",
"postal_code": "00729"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "ENRIQUE MANGUAL CANOVANAS MALL",
"address_2": "OFICINA LOCAL 14",
"city": "CANOVANAS",
"state": "PR",
"postal_code": "00729",
"telephone_number": "787-344-1277"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOPEZ CRESPO",
"first_name": "RAQUEL",
"middle_name": "IVELISSE",
"name_prefix": "Mrs.",
"credential": "PSIC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-02",
"last_updated": "2023-02-17",
"certification_date": "2023-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PR",
"license": "6375",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canovanas, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.