Healthcare Provider Details

I. General information

NPI: 1245061902
Provider Name (Legal Business Name): BRENDA IVETTE MORALES TORRES PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/13/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 CARR. KM 1 H5 BO SANTA ROSA
DORADO PR
00693
US

IV. Provider business mailing address

PO BOX 571
VEGA BAJA PR
00694-0571
US

V. Phone/Fax

Practice location:
  • Phone: 939-365-5429
  • Fax: 787-561-7464
Mailing address:
  • Phone: 939-365-5429
  • Fax: 787-561-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7581
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: