Provider Demographics
NPI:1972879823
Name:CLINICA PSICOTERAPEUTICA SISTEMICA E INTEGRATIVA, CSP
Entity Type:Organization
Organization Name:CLINICA PSICOTERAPEUTICA SISTEMICA E INTEGRATIVA, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-677-7704
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:AGUIRRE
Mailing Address - State:PR
Mailing Address - Zip Code:00704-0414
Mailing Address - Country:US
Mailing Address - Phone:787-677-7704
Mailing Address - Fax:
Practice Address - Street 1:CALLE GUAYAMA #10
Practice Address - Street 2:BO PUEBLO
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751
Practice Address - Country:US
Practice Address - Phone:787-677-7704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4104103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1366712226OtherINDIVIDUAL NPI