Provider Demographics
NPI:1104485077
Name:CLINICA PSICOLOGICA LAS MIRLAS LLC
Entity type:Organization
Organization Name:CLINICA PSICOLOGICA LAS MIRLAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:ENID
Authorized Official - Last Name:LUCIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-673-8394
Mailing Address - Street 1:PO BOX 939
Mailing Address - Street 2:
Mailing Address - City:ENSENADA
Mailing Address - State:PR
Mailing Address - Zip Code:00647-0939
Mailing Address - Country:US
Mailing Address - Phone:787-673-8394
Mailing Address - Fax:
Practice Address - Street 1:64 CALLE SAN MIGUEL
Practice Address - Street 2:
Practice Address - City:GUANICA
Practice Address - State:PR
Practice Address - Zip Code:00653-2809
Practice Address - Country:US
Practice Address - Phone:787-673-8394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty