Provider Demographics
NPI:1871723882
Name:CENTRO INTERDISCIPLINARIO PSICOTERAPEUTICO PSC
Entity type:Organization
Organization Name:CENTRO INTERDISCIPLINARIO PSICOTERAPEUTICO PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:787-602-2063
Mailing Address - Street 1:102 CALLE 1 URBANIZACION JACAGUAX
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-2532
Mailing Address - Country:US
Mailing Address - Phone:787-837-6194
Mailing Address - Fax:787-837-6194
Practice Address - Street 1:13 CALLE DE LA CRUZ
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-2426
Practice Address - Country:US
Practice Address - Phone:787-636-6661
Practice Address - Fax:787-837-6194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2562103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty