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General NPI Number Information
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NPI Number | 1497467930
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Entity Type | Organization
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Legal Business Name | SERVICIOS PSICOLOGICOS MENTE-LIBRE
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Dates
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Enumeration Date | 12/15/2022
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Last Update Date | 12/15/2022
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Provider Practice Location Address
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Address Line | TORRE MEDICA SAN VICENTE DE PAUL SUITE 410
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City | SAN GERMAN
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State | PR
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Zip | 00683
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Country | US
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Telephone | 787-531-8479
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Fax |
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Provider Business Mailing Address
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Address Line | GLENVIEW CALLE ENEAS F20
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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 | 787-531-8479
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS WIGMAR DIAZ RAMOS
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Credential |
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Telephone | 787-531-8479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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