Provider Demographics
NPI:1962733519
Name:CENTRO DE SERVICIOS SICOLOGICOS Y EDUCATIVOS EDUCENE
Entity type:Organization
Organization Name:CENTRO DE SERVICIOS SICOLOGICOS Y EDUCATIVOS EDUCENE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSICOLOGA ESCOLAR
Authorized Official - Prefix:
Authorized Official - First Name:MYRTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:787-647-1350
Mailing Address - Street 1:CALLE CUNDIAMOR 158
Mailing Address - Street 2:CIUDAD JARDIN
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:787-687-1930
Practice Address - Street 1:AVE BAIROA CALLE STA MARIA M 3
Practice Address - Street 2:URB BAIROA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-647-1350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2694261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health