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General NPI Number Information
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NPI Number | 1801196787
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Entity Type | Organization
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Legal Business Name | PSYCHE, SERVICIOS PSICOLOGICOS
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Dates
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Enumeration Date | 10/26/2010
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Last Update Date | 10/26/2010
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Provider Practice Location Address
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Address Line | 8133 CALLE MARTIN CORCHADO
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City | PONCE
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State | PR
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Zip | 00717-1123
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Country | US
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Telephone | 787-515-9770
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Fax | 787-259-9040
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Provider Business Mailing Address
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Address Line | URB. MARIANI 8133 CALLE MARTIN CORCHADO
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City | PONCE
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State | PR
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Zip | 00717-1123
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Country | US
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Telephone | 787-515-9770
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Fax | 787-259-9040
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/OWNER
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Name | DR. MARIELA LEON-VELAZQUEZ
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Credential | PH.D.
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Telephone | 787-515-9770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 3250
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License Number State | PR
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