Healthcare Provider Details

I. General information

NPI: 1598993651
Provider Name (Legal Business Name): CENTRO SICOTERAPEUTICO MULTIDISCIPLINARIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 08/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 CALLE LUCERO URB EL VERDE
CAGUAS PR
00725-6325
US

IV. Provider business mailing address

19 CALLE LUCERO URB EL VERDE
CAGUAS PR
00725-6325
US

V. Phone/Fax

Practice location:
  • Phone: 787-743-1210
  • Fax: 787-745-0242
Mailing address:
  • Phone: 787-743-1210
  • Fax: 787-745-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ERMELINDA BURGOS
Title or Position: DIRECTOR
Credential:
Phone: 787-743-1210