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General NPI Number Information
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NPI Number | 1245758325
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Entity Type | Organization
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Legal Business Name | CENTRO TERAPEUTICO PSYQUES
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Dates
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Enumeration Date | 09/08/2017
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Last Update Date | 09/13/2017
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Provider Practice Location Address
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Address Line | CARR 686 CABO CARIBE IND. PARK 1783 #2A KM 18.8
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City | VEGA BAJA
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State | PR
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Zip | 00694
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Country | US
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Telephone | 787-970-5223
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Fax | 787-970-5900
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Provider Business Mailing Address
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Address Line | P.O. BOX 1320
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City | SABANA SECA
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State | PR
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Zip | 00952
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Country | US
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Telephone | 787-970-5223
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Fax | 787-970-5900
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Authorized Official
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Title or Position | PSICOLOGA
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Name | MRS. KEYLA ENID MORIANO SR.
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Credential |
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Telephone | 787-970-5223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2870
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License Number State | PR
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