Healthcare Provider Details

I. General information

NPI: 1972320620
Provider Name (Legal Business Name): SVS PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 AVE TITO CASTRO STE 712 TORRE MEDICA SAN LUCAS
PONCE PR
00716-4722
US

IV. Provider business mailing address

PO BOX 465
MERCEDITA PR
00715-0465
US

V. Phone/Fax

Practice location:
  • Phone: 787-813-0550
  • Fax:
Mailing address:
  • Phone: 787-813-0550
  • Fax: 787-844-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: SHARON MARIE VAZQUEZ SILVA
Title or Position: PRESIDENTE
Credential: PHD
Phone: 787-813-0550