Provider Demographics
NPI:1033383112
Name:P.R. CLINICAL AND FORENSIC PSYCHOLOGICAL SERVICES INC.
Entity Type:Organization
Organization Name:P.R. CLINICAL AND FORENSIC PSYCHOLOGICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-384-4013
Mailing Address - Street 1:CALLE EUCALIPTO CB6 RIO HONDO 3
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-384-4013
Mailing Address - Fax:787-785-3985
Practice Address - Street 1:COND. LAS TORRES, SUITE 6E, TORRE SUR,
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-384-4013
Practice Address - Fax:787-785-3985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health