Healthcare Provider Details

I. General information

NPI: 1770925349
Provider Name (Legal Business Name): JTB PSYCHOLOGICAL SERVICES, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE LAUREL 2U-5 LOMAS VERDES
BAYAMON PR
00956
US

IV. Provider business mailing address

SAN RAFAEL ESTATES 134 CALLE AZUCENA
BAYAMON PR
00959
US

V. Phone/Fax

Practice location:
  • Phone: 787-379-3040
  • Fax:
Mailing address:
  • Phone: 787-379-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1871
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1871
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1871
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number1871
License Number StatePR

VIII. Authorized Official

Name: MR. JOSE A. TORRES
Title or Position: PRESIDENT
Credential: PSY. D
Phone: 787-379-3040