Healthcare Provider Details

I. General information

NPI: 1811656416
Provider Name (Legal Business Name): INTEGRANDO CENTRO EVALUATIVO Y TERAPEUTICO DRA. SO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 12/10/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. LUIS MUNOZ MARIN E-9 URB. CAGUAX
CAGUAS PR
00725
US

IV. Provider business mailing address

AVE. LUIS MUNOZ MARIN E-9 URB. CAGUAX
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 939-539-5864
  • Fax:
Mailing address:
  • Phone: 939-539-5864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. SONIA N GRAJALES-TIRADO
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 939-539-5864