Provider Demographics
NPI:1245245091
Name:SERVICIOS PSICOLOGICOS RAIGAMBRE
Entity Type:Organization
Organization Name:SERVICIOS PSICOLOGICOS RAIGAMBRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:787-292-0205
Mailing Address - Street 1:HC 645 BOX 6387
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-9746
Mailing Address - Country:US
Mailing Address - Phone:787-292-0205
Mailing Address - Fax:787-292-0205
Practice Address - Street 1:PLAZA CUPEY GARDENS SECTOR 3
Practice Address - Street 2:URB CUPEY GARDENS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-292-0205
Practice Address - Fax:787-292-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1330103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2403OtherPSYC.
PR1739OtherPSYC.
PR2246OtherPSYC.
PRA861OtherPSYC.
PR503628OtherPSYC.
PRA842OtherPSIC.
PR075148OtherPSIC.
PR1713OtherPSYC.
PR758OtherPSYCHOLOGIST
PR503628OtherPSYC.
PR758OtherPSYCHOLOGIST