Healthcare Provider Details

I. General information

NPI: 1164370581
Provider Name (Legal Business Name): BRENDALIZ PITRE MS-SSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 444 KM 2.7 INT. BO. CUCHILLAS SECTOR HERNANDEZ
MOCA PR
00676-9740
US

IV. Provider business mailing address

HC 5 BOX 10695
MOCA PR
00676-9740
US

V. Phone/Fax

Practice location:
  • Phone: 787-628-1518
  • Fax:
Mailing address:
  • Phone: 787-628-1518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number8835
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: