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General NPI Number Information
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NPI Number | 1376842450
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL CONSULTANT OF AFFECTIVE LABOR AN EDUCATIONAL TRAINING COR
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Dates
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Enumeration Date | 03/15/2011
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Last Update Date | 03/15/2011
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Provider Practice Location Address
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Address Line | CORRETERA 159 KILOMETRO 15.0 BO BORRIO PUEBLO
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City | COROZAL
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State | PR
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Zip | 00783
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Country | US
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Telephone | 787-587-3801
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Fax | 787-859-7802
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Provider Business Mailing Address
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Address Line | UR. COO BRISAS CALLE 7M-16
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City | COROZAL
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State | PR
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Zip | 00783
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Country | US
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Telephone | 787-587-3801
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Fax | 787-859-7802
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIGDALIA SANTOS MIRANDA
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Credential | PSY-D
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Telephone | 787-587-3801
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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 | 3683
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License Number State | PR
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