Provider Demographics
NPI:1598993651
Name:CENTRO SICOTERAPEUTICO MULTIDISCIPLINARIO
Entity type:Organization
Organization Name:CENTRO SICOTERAPEUTICO MULTIDISCIPLINARIO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERMELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-743-1210
Mailing Address - Street 1:19 CALLE LUCERO
Mailing Address - Street 2:URB EL VERDE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-6325
Mailing Address - Country:US
Mailing Address - Phone:787-743-1210
Mailing Address - Fax:787-745-0242
Practice Address - Street 1:19 CALLE LUCERO
Practice Address - Street 2:URB EL VERDE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-6325
Practice Address - Country:US
Practice Address - Phone:787-743-1210
Practice Address - Fax:787-745-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty