Provider Demographics
NPI:1639455611
Name:INSTITUTO MULTIDISCIPLINARIO Y EDUCATIVO DEL CENTRO
Entity Type:Organization
Organization Name:INSTITUTO MULTIDISCIPLINARIO Y EDUCATIVO DEL CENTRO
Other - Org Name:IMEC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALBA
Authorized Official - Middle Name:IRIS
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-263-8108
Mailing Address - Street 1:PO BOX 6400
Mailing Address - Street 2:SUITE 118
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-6400
Mailing Address - Country:US
Mailing Address - Phone:787-263-8108
Mailing Address - Fax:787-263-8108
Practice Address - Street 1:AVE ANTONIO R BARCELO
Practice Address - Street 2:KM 73.6
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-3717
Practice Address - Country:US
Practice Address - Phone:787-263-8108
Practice Address - Fax:787-263-8108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-23
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR898103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty