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General NPI Number Information
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NPI Number | 1871723882
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Entity Type | Organization
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Legal Business Name | CENTRO INTERDISCIPLINARIO PSICOTERAPEUTICO PSC
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Dates
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Enumeration Date | 07/24/2009
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 13 CALLE DE LA CRUZ
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City | JUANA DIAZ
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State | PR
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Zip | 00795-2426
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Country | US
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Telephone | 787-636-6661
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Fax | 787-837-6194
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Provider Business Mailing Address
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Address Line | 102 CALLE 1 URBANIZACION JACAGUAX
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City | JUANA DIAZ
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State | PR
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Zip | 00795-2532
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Country | US
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Telephone | 787-837-6194
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Fax | 787-837-6194
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RITA M MERCADO
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Credential | PSY D
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Telephone | 787-602-2063
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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 | 2562
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License Number State | PR
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