Provider Demographics
NPI:1063853505
Name:CLINICA DE SERVICIOS PSICOLOGICOS Y DEL DESARROLLO, C.S.P.
Entity Type:Organization
Organization Name:CLINICA DE SERVICIOS PSICOLOGICOS Y DEL DESARROLLO, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRISSELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDERO MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:939-339-1402
Mailing Address - Street 1:2045 AVE PEDRO ALBIZU CAMPOS STE 2
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603
Mailing Address - Country:US
Mailing Address - Phone:939-339-1402
Mailing Address - Fax:866-241-8068
Practice Address - Street 1:2045 AVE PEDRO ALBIZU CAMPOS STE 2
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:939-339-1402
Practice Address - Fax:866-241-8068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty