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General NPI Number Information
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NPI Number | 1619862521
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Entity Type | Organization
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Legal Business Name | NEURODIVERSAMENTE LLC
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 527 CALLE SERGIO CUEVAS BUSTAMANTE AVE MANUEL DOMENECH
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City | SAN JUAN
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State | PR
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Zip | 00918-2677
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Country | US
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Telephone | 787-204-6886
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Fax |
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Provider Business Mailing Address
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Address Line | 74 CALLE CONVENTO
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City | SANTA ISABEL
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State | PR
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Zip | 00757-3014
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Country | US
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Telephone | 787-204-6886
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Fax |
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Authorized Official
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Title or Position | PRESIDENTE
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Name | ISMARIE SOTO INFANTE
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Credential | PSY.D.
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Telephone | 787-204-6886
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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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