Healthcare Provider Details

I. General information

NPI: 1790241784
Provider Name (Legal Business Name): SERVICIOS PSICOLOGICOS LCDA NATALIA MARQUEZ CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419-1 CALLE LIMA EDIFICIO ANGEL R COLLAZO URBANIZACION EXTENSION FOREST HILLS
BAYAMON PR
00960
US

IV. Provider business mailing address

PO BOX 8205
BAYAMON PR
00960-8205
US

V. Phone/Fax

Practice location:
  • Phone: 787-636-2295
  • Fax:
Mailing address:
  • Phone: 787-636-2295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: NATALIA MARQUEZ
Title or Position: PSICOLOGA / OWNER
Credential: LCDA
Phone: 787-636-2295