Healthcare Provider Details

I. General information

NPI: 1356900468
Provider Name (Legal Business Name): SMART THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 802 SECTOR ROLO PACHECO
COROZAL PR
00783-0529
US

IV. Provider business mailing address

PO BOX 529
COROZAL PR
00783-0529
US

V. Phone/Fax

Practice location:
  • Phone: 787-248-9335
  • Fax:
Mailing address:
  • Phone: 787-248-9335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS IVONNE M ORTIZ MORALES
Title or Position: PRESIDENTE
Credential:
Phone: 787-248-9335