Healthcare Provider Details

I. General information

NPI: 1306658828
Provider Name (Legal Business Name): CLINICA DE SERVICIOS PSICOLOGICOS DE TRANSFORMACION INTEGRAL METAMORFOSIS PROJECT PR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 CALLE BALDORIOTY
COAMO PR
00769-2412
US

IV. Provider business mailing address

65 CALLE BALDORIOTY
COAMO PR
00769-2412
US

V. Phone/Fax

Practice location:
  • Phone: 787-614-3205
  • Fax:
Mailing address:
  • Phone: 787-614-3205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: BRENDA M ANGLADA RIVERA
Title or Position: CLINICAL PSYCHOLOGIST
Credential:
Phone: 787-614-3205