Provider Demographics
NPI:1689605057
Name:INSTITUTO PSICOTERAPEUTICO DE PR
Entity Type:Organization
Organization Name:INSTITUTO PSICOTERAPEUTICO DE PR
Other - Org Name:PUERTO RICO COUNSELLING CENTER INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:M
Authorized Official - Last Name:VARELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-753-9515
Mailing Address - Street 1:PO BOX 367221
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-7221
Mailing Address - Country:US
Mailing Address - Phone:787-753-9515
Mailing Address - Fax:787-753-8327
Practice Address - Street 1:CARR NUM 2 KM 11 8 EDIFICIO CENTURION PISO 3
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-995-2700
Practice Address - Fax:787-995-2706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRCASM0341283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10919OtherTRIPLE S