Provider Demographics
NPI:1306022124
Name:HOLISTIC DEVELOPMENT THERAPY INC
Entity type:Organization
Organization Name:HOLISTIC DEVELOPMENT THERAPY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:MINERVA
Authorized Official - Middle Name:MARTINEZ
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSICOLOGA PHD
Authorized Official - Phone:787-238-5167
Mailing Address - Street 1:URB. HACIENDA BORINQUEN CALLE EMAJAGUA 408 CAGUAS
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-238-5167
Mailing Address - Fax:787-778-3113
Practice Address - Street 1:URB. HACIENDA BORINQUEN CALLE EMAJAGUA 408 CAGUAS
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-238-5167
Practice Address - Fax:787-778-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty