Provider Demographics
NPI:1194116210
Name:STARFISH PSYCHOLOGICAL SERVICES, C.S.P.
Entity type:Organization
Organization Name:STARFISH PSYCHOLOGICAL SERVICES, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MRC
Authorized Official - Phone:787-557-2821
Mailing Address - Street 1:PO BOX 3415
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-3415
Mailing Address - Country:US
Mailing Address - Phone:787-686-6242
Mailing Address - Fax:
Practice Address - Street 1:64 CALLE HOSTOS NORTE
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-686-6242
Practice Address - Fax:787-686-6241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1055101Y00000X
PR003776103T00000X
PR1242235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty