Provider Demographics
NPI:1154773257
Name:CENTRO PSICOSOCIAL TERAPEUTICO DEL SUROESTE INC.
Entity type:Organization
Organization Name:CENTRO PSICOSOCIAL TERAPEUTICO DEL SUROESTE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:B
Authorized Official - Last Name:COLON GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:939-264-0606
Mailing Address - Street 1:11 LAS LOMAS #25
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-3605
Mailing Address - Country:US
Mailing Address - Phone:939-264-0606
Mailing Address - Fax:
Practice Address - Street 1:# 36A CALLE LUIS MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-1815
Practice Address - Country:US
Practice Address - Phone:939-264-0606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)