Provider Demographics
NPI: | 1942738570 |
---|---|
Name: | GREISTAR MENTAL & PHYSICAL HEALTH, LLC |
Entity Type: | Organization |
Organization Name: | GREISTAR MENTAL & PHYSICAL HEALTH, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | GRISELLE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GARCIA HERNANDEZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 787-374-5801 |
Mailing Address - Street 1: | 1226 CALLE CADIZ |
Mailing Address - Street 2: | URB. PUERTO NUEVO |
Mailing Address - City: | SAN JUAN |
Mailing Address - State: | PR |
Mailing Address - Zip Code: | 00920 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 787-985-0891 |
Mailing Address - Fax: | 787-985-0892 |
Practice Address - Street 1: | 1226 CALLE CADIZ |
Practice Address - Street 2: | URB. PUERTO NUEVO |
Practice Address - City: | SAN JUAN |
Practice Address - State: | PR |
Practice Address - Zip Code: | 00920-3841 |
Practice Address - Country: | US |
Practice Address - Phone: | 787-985-0891 |
Practice Address - Fax: | 787-985-0892 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-05-26 |
Last Update Date: | 2017-05-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
No | 103TH0004X | Behavioral Health & Social Service Providers | Psychologist | Health | Group - Multi-Specialty |
No | 103TH0100X | Behavioral Health & Social Service Providers | Psychologist | Health Service | Group - Multi-Specialty |
No | 103TP0016X | Behavioral Health & Social Service Providers | Psychologist | Prescribing (Medical) | Group - Multi-Specialty |
No | 103TR0400X | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation | Group - Multi-Specialty |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 106E00000X | Behavioral Health & Social Service Providers | Assistant Behavior Analyst | Group - Multi-Specialty |