Provider Demographics
NPI:1982372140
Name:KEYLIVETTE'S THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:KEYLIVETTE'S THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KEYLIVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORENGO
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:787-215-2574
Mailing Address - Street 1:17 CALLE 4 APT.1711
Mailing Address - Street 2:COLINAS DEL SOL I
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-215-2574
Mailing Address - Fax:
Practice Address - Street 1:AVE. LAUREL 3R-38 EXT. URB. LOMAS VERDES
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-215-2574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty