Provider Demographics
NPI:1811656416
Name:INTEGRANDO CENTRO EVALUATIVO Y TERAPEUTICO DRA. SO
Entity type:Organization
Organization Name:INTEGRANDO CENTRO EVALUATIVO Y TERAPEUTICO DRA. SO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:GRAJALES-TIRADO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:939-539-5864
Mailing Address - Street 1:AVE. LUIS MUNOZ MARIN E-9
Mailing Address - Street 2:URB. CAGUAX
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:939-539-5864
Mailing Address - Fax:
Practice Address - Street 1:AVE. LUIS MUNOZ MARIN E-9
Practice Address - Street 2:URB. CAGUAX
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:939-539-5864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty