=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225304702
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA CORTES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2012
-----------------------------------------------------
Last Update Date | 03/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | HC 2 BOX 7927
-----------------------------------------------------
City | GUAYANILLA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00656-9735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-412-8439
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC 2 BOX 7927
-----------------------------------------------------
City | GUAYANILLA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00656-9735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-412-8439
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | TAC-III-11-48-0329
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | TFC-III-05-20-0329
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------