Provider Demographics
NPI:1346738051
Name:PROFESIONALES AL SERVICIO DEL DESARROLLO
Entity type:Organization
Organization Name:PROFESIONALES AL SERVICIO DEL DESARROLLO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-360-4933
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00954-0460
Mailing Address - Country:US
Mailing Address - Phone:787-429-8693
Mailing Address - Fax:
Practice Address - Street 1:URB. JARDINES DE TOA ALTA CALLE 1 LOCAL 1
Practice Address - Street 2:RIO DEL PLATA MALL OFICINA 3-C
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00954
Practice Address - Country:US
Practice Address - Phone:787-429-8693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1732103T00000X, 103TC2200X, 103TM1800X
PR1592103TA0700X, 103TC0700X, 103TM1800X
PR670225X00000X, 225XP0200X
PR660235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty