Provider Demographics
NPI:1275802290
Name:ALPHA THERAPY GROUP
Entity Type:Organization
Organization Name:ALPHA THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADELITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELENDEZ VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-528-2970
Mailing Address - Street 1:CALLE 2 D7 SUITE 1
Mailing Address - Street 2:URB VILLA REAL
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE 2 D7 SUITE 1
Practice Address - Street 2:URB VILLA REAL
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00694
Practice Address - Country:US
Practice Address - Phone:787-528-2079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3472103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty