Provider Demographics
NPI:1891518189
Name:SERVICIOS PSICOLOGICOS RENUEVATE LLC
Entity type:Organization
Organization Name:SERVICIOS PSICOLOGICOS RENUEVATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSY.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-645-2587
Mailing Address - Street 1:URB. ALTURAS DE SAN BENITO
Mailing Address - Street 2:CALLE REINA DE LA PAZ 11
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-9202
Mailing Address - Country:US
Mailing Address - Phone:787-645-2587
Mailing Address - Fax:
Practice Address - Street 1:CARR. 198 KM 22.0
Practice Address - Street 2:BO. MONTONES I
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771-0198
Practice Address - Country:US
Practice Address - Phone:787-716-0050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty