Provider Demographics
NPI:1821730557
Name:PSICO-COLECTIVO, LLC
Entity Type:Organization
Organization Name:PSICO-COLECTIVO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEGRON QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:939-625-0207
Mailing Address - Street 1:URB. SANTA JUANITA
Mailing Address - Street 2:DC-15 CALLE ATENAS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:939-237-4617
Mailing Address - Fax:
Practice Address - Street 1:CALLE MONSENOR
Practice Address - Street 2:MEDINA PROFESSIONAL CENTER SUITE 703
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:939-237-4617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty