MEDICARE: CLINICA DE SERVICIOS PSICOLOGICOS DE TRANSFORMACION INTEGRAL METAMORFOSIS PROJECT PR INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1306658828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICA DE SERVICIOS PSICOLOGICOS DE TRANSFORMACION INTEGRAL METAMORFOSIS PROJECT PR INC

Provider Business Mailing Address
First Line	:	65 CALLE BALDORIOTY
Second Line	:
City	:	COAMO
State	:	PR
Zip	:	00769-2412
Country	:	US
Telephone Number	:	787-614-3205
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 CALLE BALDORIOTY
Second Line	:
City	:	COAMO
State	:	PR
Zip	:	00769-2412
Country	:	US
Telephone Number	:	787-614-3205
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	BRENDA M ANGLADA RIVERA
Credential	:
Telephone Number	:	787-614-3205

Provider Enumeration Date	:	01/22/2025
Last Update Date	:	03/06/2025

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