Provider Demographics
NPI:1427731538
Name:CENTRO PSICOLOGICO ILO SE LLC
Entity type:Organization
Organization Name:CENTRO PSICOLOGICO ILO SE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVELISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-930-3144
Mailing Address - Street 1:SAN ALFONSO
Mailing Address - Street 2:D12 CALLE MIS AMORES
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-5128
Mailing Address - Country:US
Mailing Address - Phone:787-558-8718
Mailing Address - Fax:
Practice Address - Street 1:66B JOSEFINA LEGRAND
Practice Address - Street 2:ESQUINA PALMER
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-0000
Practice Address - Country:US
Practice Address - Phone:787-903-9863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO PSICOLOGICO ILO, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty