Provider Demographics
NPI:1346752995
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:AVE ROTARIOS EDIFICIO CARDONA CAMPOS NIVEL 2
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVE ROTARIOS EDIFICIO CARDONA CAMPOS 2DO NIVEL
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
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 Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHY132AMedicaid