Provider Demographics
NPI:1275305476
Name:PSICOLOGIA INNOVADORA DEL OESTE
Entity Type:Organization
Organization Name:PSICOLOGIA INNOVADORA DEL OESTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRISSELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEAUCHAMP-CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-673-2122
Mailing Address - Street 1:URB MONTE BELLO
Mailing Address - Street 2:1027 CALLE MAJESTAD
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660
Mailing Address - Country:US
Mailing Address - Phone:939-865-3515
Mailing Address - Fax:
Practice Address - Street 1:BO LAVADERO CARR #2 KM HM 165.5
Practice Address - Street 2:
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:939-865-3515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty