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General NPI Number Information
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NPI Number | 1194519520
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Entity Type | Organization
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Legal Business Name | CLINICA DE SERVICIOS PSICOLOGICOS SERENIDAD LLC
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 22 CALLE SOL STE 101
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City | PONCE
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State | PR
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Zip | 00730-3820
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Country | US
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Telephone | 787-974-3773
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Fax |
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Provider Business Mailing Address
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Address Line | 2429 CALLE TURIN
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City | PONCE
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State | PR
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Zip | 00716-2221
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Country | US
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Telephone | 787-974-3773
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | PAULETTE T SOTO MARTINEZ
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Credential | PSYD
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Telephone | 787-974-3773
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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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