Provider Demographics
NPI:1467141085
Name:PSIQUE, CLINICA DE SALUD MENTAL L.L.C.
Entity Type:Organization
Organization Name:PSIQUE, CLINICA DE SALUD MENTAL L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YANELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-517-5430
Mailing Address - Street 1:HC 4 BOX 2933
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-9481
Mailing Address - Country:US
Mailing Address - Phone:787-517-5430
Mailing Address - Fax:
Practice Address - Street 1:68 CALLE BARCELO
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-1758
Practice Address - Country:US
Practice Address - Phone:787-517-5430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty