Provider Demographics
NPI:1083856033
Name:CENTRO DE CRECIMIENTO INDIVIDUAL Y FAMILIAR
Entity type:Organization
Organization Name:CENTRO DE CRECIMIENTO INDIVIDUAL Y FAMILIAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:MERCEDES
Authorized Official - Last Name:APONTE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-790-6448
Mailing Address - Street 1:PO BOX 7891
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-7891
Mailing Address - Country:US
Mailing Address - Phone:787-790-6448
Mailing Address - Fax:787-790-6589
Practice Address - Street 1:KM.12.4 CARRETERA 833
Practice Address - Street 2:BO. LOS FRAILES
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00971-0000
Practice Address - Country:US
Practice Address - Phone:787-790-6448
Practice Address - Fax:787-790-6589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2928103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1770754723Medicare PIN