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General NPI Number Information
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NPI Number | 1962796599
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Entity Type | Organization
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Legal Business Name | SERVICIOS PSICOLOGICOS VIVE, PSC.
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | PMB 410 DE DIEGO AVE 89 SUITE 105
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City | SAN JUAN
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State | PR
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Zip | 00927-6370
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Country | US
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Telephone | 939-639-7555
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Fax |
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Provider Business Mailing Address
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Address Line | PMB 410 DE DIEGO AVE 89 SUITE 105
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City | SAN JUAN
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State | PR
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Zip | 00927-6370
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Country | US
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Telephone | 939-639-7555
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIA CURBELO SERRANO
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Credential | PSYD
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Telephone | 939-639-7555
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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 | 3528
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License Number State | PR
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