Provider Demographics
NPI:1245758325
Name:CENTRO TERAPEUTICO PSYQUES
Entity Type:Organization
Organization Name:CENTRO TERAPEUTICO PSYQUES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSICOLOGA
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEYLA
Authorized Official - Middle Name:ENID
Authorized Official - Last Name:MORIANO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-970-5223
Mailing Address - Street 1:P.O. BOX 1320
Mailing Address - Street 2:
Mailing Address - City:SABANA SECA
Mailing Address - State:PR
Mailing Address - Zip Code:00952
Mailing Address - Country:US
Mailing Address - Phone:787-970-5223
Mailing Address - Fax:787-970-5900
Practice Address - Street 1:CARR 686 CABO CARIBE IND. PARK
Practice Address - Street 2:1783 #2A KM 18.8
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00694
Practice Address - Country:US
Practice Address - Phone:787-970-5223
Practice Address - Fax:787-970-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2870103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty