=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396063798
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENCUENTROS SERVICIOS PSICOLOGICOS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2010
-----------------------------------------------------
Last Update Date | 05/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | GASBY PLAZA 30 PADIAL SUITE 212
-----------------------------------------------------
City | CAGUAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-422-2709
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9001
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00908-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. JENNIFER A CORTES
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 787-422-2709
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 3520
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------