Provider Demographics
NPI:1548674518
Name:INSTITUTO DE CAPACITACION Y DESARROLLO PROFESIONAL INC.
Entity type:Organization
Organization Name:INSTITUTO DE CAPACITACION Y DESARROLLO PROFESIONAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-513-7908
Mailing Address - Street 1:1606 AVE PONCE DE LEON
Mailing Address - Street 2:SUITE 1005
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-1849
Mailing Address - Country:US
Mailing Address - Phone:787-513-7908
Mailing Address - Fax:787-724-6604
Practice Address - Street 1:1606 AVE. PONCE DE LEON
Practice Address - Street 2:SUITE 1005
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2839
Practice Address - Country:US
Practice Address - Phone:787-513-7908
Practice Address - Fax:787-724-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty