Provider Demographics
NPI:1508625849
Name:CASILLAS PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:CASILLAS PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CASILLAS CANALES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYCHOLOGIST
Authorized Official - Phone:787-248-0486
Mailing Address - Street 1:718 CALLE CIPRES
Mailing Address - Street 2:URB HIGHLAND PARK
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-248-0486
Mailing Address - Fax:
Practice Address - Street 1:416 AVE PONCE DE LEON STE 912
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3425
Practice Address - Country:US
Practice Address - Phone:787-248-0486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty