Healthcare Provider Details

I. General information

NPI: 1225387533
Provider Name (Legal Business Name): INNOVATIVO PSYCOEDUCATIONAL & CONSULTING SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

D81 CALLE C DORADO OFFICE SUITES, COSTA DE ORO
DORADO PR
00646-2051
US

IV. Provider business mailing address

DORADO OFFICE SUITE CALLE C D-81
DORADO PR
00646
US

V. Phone/Fax

Practice location:
  • Phone: 787-617-8617
  • Fax:
Mailing address:
  • Phone: 787-617-8617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3160
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CAROL SALAS
Title or Position: PRESIDENT
Credential: PSY.D
Phone: 787-617-8617