Provider Demographics
NPI:1275676108
Name:RED METROPOLITANA DE PSICOLOGIA, CSP
Entity Type:Organization
Organization Name:RED METROPOLITANA DE PSICOLOGIA, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINGO
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARQUES
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:787-725-5013
Mailing Address - Street 1:607 AVE CONDADO
Mailing Address - Street 2:CONDOMINIO CONDADO SUITE 401
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3845
Mailing Address - Country:US
Mailing Address - Phone:787-725-5013
Mailing Address - Fax:
Practice Address - Street 1:607 AVE CONDADO
Practice Address - Street 2:CONDOMINIO CONDADO SUITE 401
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00907-3845
Practice Address - Country:US
Practice Address - Phone:787-725-5013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2762103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty