Provider Demographics
NPI:1912697046
Name:CLINICA PSICOTERAPEUTICA INTEGRAL COGNOSIS
Entity Type:Organization
Organization Name:CLINICA PSICOTERAPEUTICA INTEGRAL COGNOSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:ISAIAH
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:939-759-5489
Mailing Address - Street 1:URB ESTANCIAS DE SANTA ISABEL CALLE AMATISTA
Mailing Address - Street 2:115
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757
Mailing Address - Country:US
Mailing Address - Phone:787-579-4370
Mailing Address - Fax:
Practice Address - Street 1:CARR 153 KM 7.5 BO PASO SECO SECTOR USERAS
Practice Address - Street 2:101
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757
Practice Address - Country:US
Practice Address - Phone:787-579-4370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty