Provider Demographics
NPI:1235541061
Name:CENTRO DE APOYO PARA EL DESARROLLO INTEGRAL DEL INDIVIDUO Y LA FAMILIA
Entity Type:Organization
Organization Name:CENTRO DE APOYO PARA EL DESARROLLO INTEGRAL DEL INDIVIDUO Y LA FAMILIA
Other - Org Name:CADIF
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-640-0358
Mailing Address - Street 1:PO BOX 4025
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-4025
Mailing Address - Country:US
Mailing Address - Phone:787-640-0358
Mailing Address - Fax:
Practice Address - Street 1:1135 65 INTANTERIA AVE.
Practice Address - Street 2:ITURREGUI PLAZA SUITE 207
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3489
Practice Address - Country:US
Practice Address - Phone:787-640-0358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3285103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty