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General NPI Number Information
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NPI Number | 1124987169
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Entity Type | Organization
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Legal Business Name | PSYBLUM PSYCHOLOGICAL SERVICE LLC
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Dates
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Enumeration Date | 01/16/2026
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | AVE LAS AMERICA EDIFICIO PORRATA PILA 209
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City | PONCE
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State | PR
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Zip | 00717
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Country | US
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Telephone | 787-999-9999
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Fax |
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Provider Business Mailing Address
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Address Line | AVE LAS AMERICA EDIFICIO PORRATA PILA 209
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City | PONCE
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State | PR
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Zip | 00717
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROPETARIA
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Name | ARIELYS ORENGO
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Credential | PSYD
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Telephone | 787-999-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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