Healthcare Provider Details

I. General information

NPI: 1821690504
Provider Name (Legal Business Name): CENTRO DE PSICOTERAPIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 07/16/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 129 KM 25.4
LARES PR
00669
US

IV. Provider business mailing address

PO BOX 1161
BARCELONETA PR
00617-1161
US

V. Phone/Fax

Practice location:
  • Phone: 787-374-7192
  • Fax:
Mailing address:
  • Phone: 787-374-7192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE ENRIQUE SARAZU
Title or Position: PRESIDENT
Credential: PSYD
Phone: 787-374-7192