Provider Demographics
NPI:1447549209
Name:ALIANZA PSICOSOCIAL DE PUERTO RICO, INC.
Entity type:Organization
Organization Name:ALIANZA PSICOSOCIAL DE PUERTO RICO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:COSME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-685-5074
Mailing Address - Street 1:PO BOX 367587
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-7587
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:RESIDENCIAL YUQUIYU CARRETERA PR 187 KM. 11.1
Practice Address - Street 2:
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772-1863
Practice Address - Country:US
Practice Address - Phone:787-685-5074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0444103TA0400X, 103TC0700X
PR1567103TC0700X
PR3932103TC0700X
PR3649103TC0700X
PR3880103TC0700X
PR95121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty