Provider Demographics
NPI:1124269600
Name:CENTRO DE SERVICIOS PROFESIONALES DE SALUD MENTAL ESPERANZA INC.
Entity type:Organization
Organization Name:CENTRO DE SERVICIOS PROFESIONALES DE SALUD MENTAL ESPERANZA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PRECIDENTE ADMINISTRADOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GONZALEZ
Authorized Official - Middle Name:MARCUCCI
Authorized Official - Last Name:MYRNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-872-7314
Mailing Address - Street 1:URBANIZACION MANSIONES DEL ATLANTICO 556
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662
Mailing Address - Country:US
Mailing Address - Phone:787-242-1100
Mailing Address - Fax:787-872-7314
Practice Address - Street 1:CALLE BARBOSA
Practice Address - Street 2:68
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-872-7314
Practice Address - Fax:787-872-7314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR54786103T00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty