MEDICARE: CENTRO DE DESARROLLO PSICO-ORGANIZACIONAL Y PSICOEDUCATIVO, INC.

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1770777005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO DE DESARROLLO PSICO-ORGANIZACIONAL Y PSICOEDUCATIVO, INC.

Provider Business Mailing Address
First Line	:	1474 AVE SAN IGNACIO
Second Line	:	URB. ALTAMESA
City	:	SAN JUAN
State	:	PR
Zip	:	00921-4739
Country	:	US
Telephone Number	:	787-707-1090
Fax Number	:

Provider Business Practice Location Address
First Line	:	1474 AVE SAN IGNACIO
Second Line	:	URB. ALTAMESA
City	:	SAN JUAN
State	:	PR
Zip	:	00921-4739
Country	:	US
Telephone Number	:	787-707-1090
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGY
Name	:	MARIEANNE COTT POLLOCK
Credential	:	PHD
Telephone Number	:	787-707-1090

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	12/14/2011

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