Provider Demographics
NPI:1396576369
Name:TRANSFORMA PSYCHOLOGY GROUP
Entity type:Organization
Organization Name:TRANSFORMA PSYCHOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSICOLOGA CLINICA
Authorized Official - Prefix:DR
Authorized Official - First Name:KENIA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-515-5124
Mailing Address - Street 1:LAS PRADERAS 1071 CALLE JASPE
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617
Mailing Address - Country:US
Mailing Address - Phone:787-515-5124
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 CALLE MARGINAL REPARTO SAN MIGUEL
Practice Address - Street 2:KM 81 # 1
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-515-5124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty