Provider Demographics
NPI:1003045758
Name:SERVICIOS PSICOLOGICOS EDUCATIVOS
Entity Type:Organization
Organization Name:SERVICIOS PSICOLOGICOS EDUCATIVOS
Other - Org Name:MARISOL SANTIAGO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARISOL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-832-2117
Mailing Address - Street 1:URB. PASEOS LOS ROBLES,
Mailing Address - Street 2:EPIFANIO VIDAL # 1526
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-832-2117
Mailing Address - Fax:787-891-2768
Practice Address - Street 1:INTER 460 RAMAL 111
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-832-2117
Practice Address - Fax:787-891-2768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2506103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty