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General NPI Number Information
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NPI Number | 1285191692
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Entity Type | Organization
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Legal Business Name | MCG AND THE ABLE CHILD INC
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Dates
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Enumeration Date | 02/22/2019
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Last Update Date | 02/22/2019
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Provider Practice Location Address
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Address Line | 1 CALLE ALBOLOTE SUITE 201 202 CENTRO COMERCIAL PLAZA
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City | GUAYNABO
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State | PR
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Zip | 00969
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Country | US
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Telephone | 787-789-1620
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Fax |
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Provider Business Mailing Address
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Address Line | 291 AVE WINSTON CHURCHILL EL SENORIAL
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-293-0147
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Fax | 787-293-0150
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ALFREDO GOTAY ZORRILLA
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Credential |
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Telephone | 787-293-0147
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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 |
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License Number State |
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Taxonomy #2
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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 |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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