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General NPI Number Information
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NPI Number | 1811139942
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Entity Type | Organization
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Legal Business Name | CENTRO INTERDISCIPLINARIO PSICOEDUCATIVO
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Dates
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Enumeration Date | 04/06/2009
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Last Update Date | 04/06/2009
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Provider Practice Location Address
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Address Line | URB VILLA GRILLASCA CALLE VIRGELIO BIAGGI 906
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City | PONCE
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State | PR
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Zip | 00717
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Country | US
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Telephone | 787-840-7928
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Fax |
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Provider Business Mailing Address
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Address Line | VILLA GRILLASRA 906 VIRGILIO BIAGGI
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City | PONCE
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State | PR
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Zip | 00717
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Country | US
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Telephone | 787-840-7928
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Fax | 787-290-2475
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Authorized Official
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Title or Position | DIRECTOR
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Name | SARAH V BAEZ
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Credential | CLINICAL PSYCHOLOGIS
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Telephone | 787-840-7928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 558
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 803
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License Number State | PR
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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 | 032
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License Number State | PR
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