Provider Demographics
NPI:1306358965
Name:GRUPO DE SERVICIOS ESPECIALIZADOS EN PSICOLOGIA E INTERGATIVOS CORP
Entity Type:Organization
Organization Name:GRUPO DE SERVICIOS ESPECIALIZADOS EN PSICOLOGIA E INTERGATIVOS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMARILIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS-RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-404-5933
Mailing Address - Street 1:PO BOX 3563
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-3563
Mailing Address - Country:US
Mailing Address - Phone:787-404-5933
Mailing Address - Fax:
Practice Address - Street 1:A11 CALLE GRANADA REPARTO ALHAMBRA LOCAL D
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-404-5933
Practice Address - Fax:787-404-5933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
PR103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHY132AMedicaid