Provider Demographics
NPI:1427486281
Name:COGNITIVE WELLNESS CLINIC, PSC
Entity type:Organization
Organization Name:COGNITIVE WELLNESS CLINIC, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-644-5219
Mailing Address - Street 1:PO BOX 1307
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-1307
Mailing Address - Country:US
Mailing Address - Phone:787-900-6081
Mailing Address - Fax:
Practice Address - Street 1:346 AVE. HOSTOS
Practice Address - Street 2:MEDICAL EMPORIUM II SUITE A-31
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-900-6081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center