Provider Demographics
NPI:1841726312
Name:ORGANIZACION DE AYUDA SICOLOGICA INTEGRAL Y SOCIAL
Entity type:Organization
Organization Name:ORGANIZACION DE AYUDA SICOLOGICA INTEGRAL Y SOCIAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:MODESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCDO
Authorized Official - Phone:787-232-3011
Mailing Address - Street 1:30 CALLE AMATISTA
Mailing Address - Street 2:URB VILLA BLANCA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-1904
Mailing Address - Country:US
Mailing Address - Phone:787-232-3011
Mailing Address - Fax:
Practice Address - Street 1:506A CALLE JUAN J JIMENEZ
Practice Address - Street 2:AVENIDA DOMENECH
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-1904
Practice Address - Country:US
Practice Address - Phone:787-232-3011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5365261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)