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General NPI Number Information
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NPI Number | 1861158156
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Entity Type | Organization
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Legal Business Name | CENTRO PSICOTERAPEUTICO INTEGRADO SINERGIA
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Dates
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Enumeration Date | 11/11/2021
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | AVE. LOS VETERANOS KM 136.7 URB. VILLA ROSA 3, A23 LOCAL 2 (FRENTE A CENTRICO)
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City | GUAYAMA
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State | PR
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Zip | 00784
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Country | US
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Telephone | 787-557-2677
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Fax |
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Provider Business Mailing Address
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Address Line | URB EL DORADO CALLE JAZMIN A6-A7
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City | GUAYAMA
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State | PR
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Zip | 00784
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Country | US
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Telephone | 787-557-2677
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ CLINICAL SOCIAL WORKER
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Name | MR. DOMINGO L ACOSTA
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Credential | MSW
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Telephone | 787-557-2677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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