Provider Demographics
NPI:1801196787
Name:PSYCHE, SERVICIOS PSICOLOGICOS
Entity Type:Organization
Organization Name:PSYCHE, SERVICIOS PSICOLOGICOS
Other - Org Name:PSYCHE, SERVICIOS PSICOLOGICOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON-VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-515-9770
Mailing Address - Street 1:URB. MARIANI
Mailing Address - Street 2:8133 CALLE MARTIN CORCHADO
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1123
Mailing Address - Country:US
Mailing Address - Phone:787-515-9770
Mailing Address - Fax:787-259-9040
Practice Address - Street 1:8133 CALLE MARTIN CORCHADO
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1123
Practice Address - Country:US
Practice Address - Phone:787-515-9770
Practice Address - Fax:787-259-9040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3250261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)