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General NPI Number Information
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NPI Number | 1235541061
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Entity Type | Organization
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Legal Business Name | CENTRO DE APOYO PARA EL DESARROLLO INTEGRAL DEL INDIVIDUO Y LA FAMILIA
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Dates
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Enumeration Date | 05/28/2014
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Last Update Date | 05/28/2014
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Provider Practice Location Address
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Address Line | 1135 65 INTANTERIA AVE. ITURREGUI PLAZA SUITE 207
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City | SAN JUAN
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State | PR
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Zip | 00924-3489
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Country | US
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Telephone | 787-640-0358
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4025
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City | CAROLINA
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State | PR
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Zip | 00984-4025
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Country | US
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Telephone | 787-640-0358
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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. SALLY QUINONES
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Credential | PSY.D
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Telephone | 787-640-0358
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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 | 3285
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License Number State | PR
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