Provider Demographics
NPI:1548599806
Name:CENTRO DE TERAPIA PSICOEDUCATIVA RETOS, CORP
Entity Type:Organization
Organization Name:CENTRO DE TERAPIA PSICOEDUCATIVA RETOS, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGY/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLASINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-646-9631
Mailing Address - Street 1:URB. MANSIONES DE LOS CEDROS
Mailing Address - Street 2:#149 CALLE CAOBA
Mailing Address - City:CAYEY
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00736
Mailing Address - Country:UM
Mailing Address - Phone:787-646-9631
Mailing Address - Fax:787-263-4822
Practice Address - Street 1:#149 CALLE CAOBA
Practice Address - Street 2:URB. MANSIONES DE LOS CEDROS
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-646-9631
Practice Address - Fax:787-263-4822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2628103T00000X
PR2228103TC2200X
PR3325106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty