Healthcare Provider Details

I. General information

NPI: 1548599806
Provider Name (Legal Business Name): CENTRO DE TERAPIA PSICOEDUCATIVA RETOS, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#149 CALLE CAOBA URB. MANSIONES DE LOS CEDROS
CAYEY PR
00736
US

IV. Provider business mailing address

URB. MANSIONES DE LOS CEDROS #149 CALLE CAOBA
CAYEY PUERTO RICO
00736
UM

V. Phone/Fax

Practice location:
  • Phone: 787-646-9631
  • Fax: 787-263-4822
Mailing address:
  • Phone: 787-646-9631
  • Fax: 787-263-4822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2628
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2228
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3325
License Number StatePR

VIII. Authorized Official

Name: MRS. AILEEN BLASINI
Title or Position: PSYCHOLOGY/DIRECTOR
Credential:
Phone: 787-646-9631