Healthcare Provider Details

I. General information

NPI: 1982372140
Provider Name (Legal Business Name): KEYLIVETTE'S THERAPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. LAUREL 3R-38 EXT. URB. LOMAS VERDES
BAYAMON PR
00957
US

IV. Provider business mailing address

17 CALLE 4 APT.1711 COLINAS DEL SOL I
BAYAMON PR
00957
US

V. Phone/Fax

Practice location:
  • Phone: 787-215-2574
  • Fax:
Mailing address:
  • Phone: 787-215-2574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. KEYLIVETTE ORENGO
Title or Position: PRESIDENT
Credential: M.S.
Phone: 787-215-2574