Provider Demographics
NPI:1588859938
Name:CLINICA DE SERVICIOS PSICOLOGICOS Y OPCIONES PSICOEDUCATIVAS
Entity Type:Organization
Organization Name:CLINICA DE SERVICIOS PSICOLOGICOS Y OPCIONES PSICOEDUCATIVAS
Other - Org Name:CLINICA DE SERVICIOS PSICOLOGICOS Y OPCIONES PSICOEDUCATIVAS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:MORALES
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-784-1645
Mailing Address - Street 1:PO BOX 50855
Mailing Address - Street 2:LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-0855
Mailing Address - Country:US
Mailing Address - Phone:787-784-1645
Mailing Address - Fax:787-795-2411
Practice Address - Street 1:2828 AVE DOS PALMAS
Practice Address - Street 2:LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4106
Practice Address - Country:US
Practice Address - Phone:787-784-1645
Practice Address - Fax:787-795-2411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2015103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherPLANES MEDICOS