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General NPI Number Information
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NPI Number | 1528197704
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Entity Type | Organization
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Legal Business Name | OFICINA DE AYUDA SICOLOGICA Y SERVICIOS INTEGRADOS
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | CARR 441 BARRIO CARRIZALES KM 2.8
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City | AGUADA
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State | PR
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Zip | 00602
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Country | US
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Telephone | 787-252-6646
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Fax | 787-252-6646
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Provider Business Mailing Address
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Address Line | PO BOX 4223
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City | AGUADILLA
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State | PR
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Zip | 00605-4223
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Country | US
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Telephone | 787-252-6646
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Fax | 787-252-6646
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Authorized Official
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Title or Position | SICOLOGA
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Name | MRS. BRENDA JANICE CRESPO
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Credential | M.A
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Telephone | 787-252-6646
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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 | 1710
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License Number State | PR
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