Provider Demographics
NPI:1033125273
Name:CRECE
Entity Type:Organization
Organization Name:CRECE
Other - Org Name:CENTROS DE RECURSOS EDUCATIVOS ESPECIALIZADOS Y PSICOLOGICOS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:VIDAL
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:939-338-8487
Mailing Address - Street 1:PO BOX 190733
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-0733
Mailing Address - Country:US
Mailing Address - Phone:939-338-8487
Mailing Address - Fax:939-338-8487
Practice Address - Street 1:500 MUNOZ RIVERA AVE
Practice Address - Street 2:CONDOMINIO EL CENTRO II OFFICE 302
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:939-338-8487
Practice Address - Fax:939-338-8487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0961103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty