Provider Demographics
NPI:1932557428
Name:CLINICA MULTIDISCIPLINARIA LIBELULA
Entity Type:Organization
Organization Name:CLINICA MULTIDISCIPLINARIA LIBELULA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:YELENNA
Authorized Official - Middle Name:MARIEL
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:787-449-4092
Mailing Address - Street 1:C27 CALLE VIA SAN JUAN
Mailing Address - Street 2:URB ESTANCIA PLAZA 10
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-449-4092
Mailing Address - Fax:
Practice Address - Street 1:C27 CALLE VIA SAN JUAN
Practice Address - Street 2:URB ESTANCIA PLAZA 10
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-449-4092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty