Provider Demographics
NPI:1821281551
Name:EMOTIONAL & MENTAL CONSULTING SERVICES CSP
Entity Type:Organization
Organization Name:EMOTIONAL & MENTAL CONSULTING SERVICES CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:HERNANDEZ - ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-259-1265
Mailing Address - Street 1:2225 PONCE BYP
Mailing Address - Street 2:STE 709
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1321
Mailing Address - Country:US
Mailing Address - Phone:787-259-1265
Mailing Address - Fax:787-259-1266
Practice Address - Street 1:2225 PONCE BYP
Practice Address - Street 2:STE 709
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1321
Practice Address - Country:US
Practice Address - Phone:787-259-1265
Practice Address - Fax:787-259-1266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4575261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)