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General NPI Number Information
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NPI Number | 1174023535
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Entity Type | Organization
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Legal Business Name | BLVD PSYCHOLOGICAL SERVICES P.S.C.
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Dates
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Enumeration Date | 02/12/2018
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Last Update Date | 10/22/2018
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Provider Practice Location Address
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Address Line | 3326 PASEO CARMEN
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City | TOA BAJA
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State | PR
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Zip | 00949-3136
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Country | US
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Telephone | 939-399-3371
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Fax | 939-399-3372
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Provider Business Mailing Address
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Address Line | 3326 PASEO CARMEN
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City | TOA BAJA
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State | PR
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Zip | 00949-3136
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Country | US
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Telephone | 939-399-3371
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Fax | 939-399-3372
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Authorized Official
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Title or Position | PRESIDENTA/DIRECTORA
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Name | BRENDALY GARCIA MORALES
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Credential | PSY D
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Telephone | 787-462-1730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State | PR
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Taxonomy #5
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number |
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License Number State | PR
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Taxonomy #6
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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