Provider Demographics
NPI:1659762664
Name:CLINICA MEDICA PSICOTERAPEUTICA DEL NORTE
Entity Type:Organization
Organization Name:CLINICA MEDICA PSICOTERAPEUTICA DEL NORTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-392-3821
Mailing Address - Street 1:PO BOX 141434
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-1434
Mailing Address - Country:US
Mailing Address - Phone:787-392-3821
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA JOSE DE DIEGO CALLE ESTEBAN PADILLA #311
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-392-3821
Practice Address - Fax:787-820-3569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC0700X
PR103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty