Provider Demographics
NPI:1770365561
Name:PLENITUD PSICOTERAPIA Y AUTOCUIDADO LLC
Entity type:Organization
Organization Name:PLENITUD PSICOTERAPIA Y AUTOCUIDADO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:ANIBAL
Authorized Official - Last Name:FUENTES FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:939-640-2984
Mailing Address - Street 1:CALLE SEVERO ARANA #21 SUITE B
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685
Mailing Address - Country:US
Mailing Address - Phone:787-896-1313
Mailing Address - Fax:
Practice Address - Street 1:CALLE SEVERO ARANA #21 SUITE B
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-896-1313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty