Provider Demographics
NPI:1790100691
Name:CREATIVE THERAPY CENTER
Entity Type:Organization
Organization Name:CREATIVE THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-637-1159
Mailing Address - Street 1:PO BOX 4193
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00958-1193
Mailing Address - Country:US
Mailing Address - Phone:787-637-1159
Mailing Address - Fax:787-545-4246
Practice Address - Street 1:CARR 167
Practice Address - Street 2:MARGINAL BELLA VISTA U-1
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-4477
Practice Address - Country:US
Practice Address - Phone:787-637-1159
Practice Address - Fax:787-545-4246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2286103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty