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General NPI Number Information
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NPI Number | 1003188244
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Entity Type | Organization
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Legal Business Name | EOS: PSYCHOLOGICAL WELLNESS CENTRE
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Dates
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Enumeration Date | 02/03/2012
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | AVE MONSERRATE AB 18 LOCAL 4 VALLE ARRIBA HEIGHTS
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City | CAROLINA
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State | PR
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Zip | 00985
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Country | US
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Telephone | 787-550-9708
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Fax |
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Provider Business Mailing Address
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Address Line | CALLE 31 AF 24 URB. INTERAMERICANA
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976
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Country | US
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Telephone | 787-550-9708
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. AGNES SYBEL DIAZ
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Credential | PH.D.
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Telephone | 787-550-9708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 4105
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License Number State | PR
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