Provider Demographics
NPI:1538471115
Name:SERVICIOS INTEGRADOS DE SALUD MENTAL INC
Entity Type:Organization
Organization Name:SERVICIOS INTEGRADOS DE SALUD MENTAL INC
Other - Org Name:SERVICIOS INTEGRADOS DE SALUD MENTAL INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:DEL AMOR
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR PSYCOLOGY
Authorized Official - Phone:787-691-2973
Mailing Address - Street 1:25 BLVD MEDIA LUNA
Mailing Address - Street 2:COND. PARQUE DE LAS FLORES, APT. 704
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-4822
Mailing Address - Country:US
Mailing Address - Phone:787-373-7079
Mailing Address - Fax:787-707-8988
Practice Address - Street 1:1404 AVE PAZ GRANELA
Practice Address - Street 2:SANTIAGO IGLESIAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4131
Practice Address - Country:US
Practice Address - Phone:787-373-7079
Practice Address - Fax:787-707-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2141103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRP78513Medicare UPIN
PR0021308Medicare PIN