Provider Demographics
NPI:1912092917
Name:CORPORACION PSICOPEDAGOGICA
Entity Type:Organization
Organization Name:CORPORACION PSICOPEDAGOGICA
Other - Org Name:CONSULTORIO PSICOLOGICO Y EDUCATIVO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA-CASTANO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-250-7414
Mailing Address - Street 1:PLAZA SAN FRANCISCO, SUITE 105
Mailing Address - Street 2:201 DE DIEGO AVENUE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:787-250-7414
Mailing Address - Fax:787-759-5093
Practice Address - Street 1:PLAZA SAN FRANCISCO, SUITE 105
Practice Address - Street 2:201 DE DIEGO AVENUE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-250-7414
Practice Address - Fax:787-759-5093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1028103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR075040OtherCRUZ AZUL
PR=========OtherMAPFRE
PR075040OtherCRUZ AZUL
PR=========OtherCOSVI