Provider Demographics
NPI:1376842450
Name:PROFESSIONAL CONSULTANT OF AFFECTIVE LABOR AN EDUCATIONAL TRAINING COR
Entity Type:Organization
Organization Name:PROFESSIONAL CONSULTANT OF AFFECTIVE LABOR AN EDUCATIONAL TRAINING COR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIGDALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:PSY-D
Authorized Official - Phone:787-587-3801
Mailing Address - Street 1:UR. COO BRISAS CALLE 7M-16
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783
Mailing Address - Country:US
Mailing Address - Phone:787-587-3801
Mailing Address - Fax:787-859-7802
Practice Address - Street 1:CORRETERA 159 KILOMETRO 15.0
Practice Address - Street 2:BO BORRIO PUEBLO
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-587-3801
Practice Address - Fax:787-859-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3683103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty