Provider Demographics
NPI:1457719809
Name:IQ CONSULTING GROUP
Entity Type:Organization
Organization Name:IQ CONSULTING GROUP
Other - Org Name:IQ NEUROSCIENCE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-231-8897
Mailing Address - Street 1:700 AVE JOBOS APT 763
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-5513
Mailing Address - Country:US
Mailing Address - Phone:787-231-8897
Mailing Address - Fax:
Practice Address - Street 1:700 AVE JOBOS APT 763
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-5513
Practice Address - Country:US
Practice Address - Phone:787-231-8897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-31
Last Update Date:2016-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00650-9639103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR103K00000XMedicare PIN