Provider Demographics
NPI:1619862521
Name:NEURODIVERSAMENTE LLC
Entity type:Organization
Organization Name:NEURODIVERSAMENTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:ISMARIE
Authorized Official - Middle Name:SOTO
Authorized Official - Last Name:INFANTE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-204-6886
Mailing Address - Street 1:74 CALLE CONVENTO
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-3014
Mailing Address - Country:US
Mailing Address - Phone:787-204-6886
Mailing Address - Fax:
Practice Address - Street 1:CALLE SERGIO CUEVAS BUSTAMANTE LOCAL 327
Practice Address - Street 2:AVE MANUEL DOMENECH
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-204-6886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty