Provider Demographics
NPI:1962612754
Name:RS PSYCOLOGICAL CLINIC, INC.
Entity type:Organization
Organization Name:RS PSYCOLOGICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YAZMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-444-1120
Mailing Address - Street 1:PO BOX 334
Mailing Address - Street 2:
Mailing Address - City:ENSENADA
Mailing Address - State:PR
Mailing Address - Zip Code:00647-0334
Mailing Address - Country:US
Mailing Address - Phone:787-444-1120
Mailing Address - Fax:787-834-8811
Practice Address - Street 1:BO COLOMBIA #70 CALLE RELAMPAGO
Practice Address - Street 2:SUITE 104
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-444-1120
Practice Address - Fax:787-834-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2588103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherEIN