MEDICARE: SERVICIOS PSICOLOGICOS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center	002079	PR

General Provider Information

NPI Number	:	1497177372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERVICIOS PSICOLOGICOS LLC

Provider Business Mailing Address
First Line	:	220 PLAZA WESTERN AUTO STE 101
Second Line	:	PMB 400
City	:	TRUJILLO ALTO
State	:	PR
Zip	:	00976-3607
Country	:	US
Telephone Number	:	787-391-0044
Fax Number	:	787-622-4432

Provider Business Practice Location Address
First Line	:	RIO PIEDRAS HEIGHTS - TINTO ST. 1733
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-0000
Country	:	US
Telephone Number	:	787-622-4433
Fax Number	:	787-622-4432

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ARACELI PERONA
Credential	:	PHD
Telephone Number	:	787-391-0044

Provider Enumeration Date	:	01/13/2014
Last Update Date	:	01/13/2014

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Directions to “SERVICIOS PSICOLOGICOS LLC ” Practice Location

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