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General NPI Number Information
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NPI Number | 1588859938
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Entity Type | Organization
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Legal Business Name | CLINICA DE SERVICIOS PSICOLOGICOS Y OPCIONES PSICOEDUCATIVAS
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 2828 AVE DOS PALMAS LEVITTOWN
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City | TOA BAJA
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State | PR
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Zip | 00949-4106
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Country | US
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Telephone | 787-784-1645
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Fax | 787-795-2411
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Provider Business Mailing Address
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Address Line | PO BOX 50855 LEVITTOWN
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City | TOA BAJA
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State | PR
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Zip | 00950-0855
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Country | US
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Telephone | 787-784-1645
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Fax | 787-795-2411
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUANITA MORALES GUZMAN
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Credential | PH.D.
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Telephone | 787-784-1645
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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 | 2015
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License Number State | PR
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