Provider Demographics
NPI:1962821918
Name:CENTRO PSICOLOGICO LLC
Entity Type:Organization
Organization Name:CENTRO PSICOLOGICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZULMA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAISONAVE
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:787-819-0992
Mailing Address - Street 1:PO BOX 4245
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-4245
Mailing Address - Country:US
Mailing Address - Phone:787-819-0992
Mailing Address - Fax:
Practice Address - Street 1:# 151 AVE. PEDRO ALBIZU
Practice Address - Street 2:SUITE 2
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-819-0992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1719261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center