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General NPI Number Information
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NPI Number | 1477943207
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Entity Type | Organization
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Legal Business Name | CORRECTIONAL HEALTH SERVICES CORPORATION
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 02/02/2015
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Provider Practice Location Address
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Address Line | 235 CALLE MIGUEL RIVERA TEXIDOR ESTANCIAS DEL GOLF
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City | PONCE
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State | PR
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Zip | 00730-0530
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Country | US
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Telephone | 787-632-3942
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Fax | 787-841-6127
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Provider Business Mailing Address
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Address Line | 235 CALLE MIGUEL RIVERA TEXIDOR ESTANCIAS DEL GOLF
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City | PONCE
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State | PR
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Zip | 00730
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Country | US
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Telephone | 787-632-3942
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Fax | 787-841-6127
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Authorized Official
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Title or Position | PSICOLOGA CLINICA
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Name | DR. REBECA CHRISTINA HERNANDEZ
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Credential | PSY. D.
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Telephone | 787-632-3942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 2484
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 2484
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License Number State | PR
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