Healthcare Provider Details

I. General information

NPI: 1346738051
Provider Name (Legal Business Name): PROFESIONALES AL SERVICIO DEL DESARROLLO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. JARDINES DE TOA ALTA CALLE 1 LOCAL 1 RIO DEL PLATA MALL OFICINA 3-C
TOA ALTA PR
00954
US

IV. Provider business mailing address

PO BOX 460
TOA ALTA PR
00954-0460
US

V. Phone/Fax

Practice location:
  • Phone: 787-429-8693
  • Fax:
Mailing address:
  • Phone: 787-429-8693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1732
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number1592
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1732
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number1732
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number1592
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number670
License Number StatePR
# 7
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number670
License Number StatePR
# 8
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number660
License Number StatePR
# 9
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1592
License Number StatePR

VIII. Authorized Official

Name: DR. MAYRA S TORRES
Title or Position: CLINICAL PSYCHOLOGY
Credential: PSYD
Phone: 787-360-4933