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General NPI Number Information
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NPI Number | 1811656416
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Entity Type | Organization
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Legal Business Name | INTEGRANDO CENTRO EVALUATIVO Y TERAPEUTICO DRA. SO
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Dates
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Enumeration Date | 12/10/2021
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Last Update Date | 12/10/2021
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Provider Practice Location Address
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Address Line | AVE. LUIS MUNOZ MARIN E-9 URB. CAGUAX
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 939-539-5864
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Fax |
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Provider Business Mailing Address
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Address Line | AVE. LUIS MUNOZ MARIN E-9 URB. CAGUAX
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 939-539-5864
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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. SONIA N GRAJALES-TIRADO
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Credential | PHD
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Telephone | 939-539-5864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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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 | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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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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