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General NPI Number Information
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NPI Number | 1619632189
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Entity Type | Organization
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Legal Business Name | CENTER FOR ADVANCE COGNITIVE STUDIES LLC
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Dates
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Enumeration Date | 11/01/2021
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | VILLA CONTESSA EE10 CALLE MARGINAL
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City | BAYAMON
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State | PR
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Zip | 00956
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Country | US
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Telephone | 787-533-3996
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Fax |
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Provider Business Mailing Address
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Address Line | F1 CALLE 13
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City | BAYAMON
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State | PR
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Zip | 00959-4829
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Country | US
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Telephone | 787-533-3996
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. ASTRID N GANDARILLA
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Credential | MSCP, LPC
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Telephone | 787-533-3996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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