1780424622 NPI number — EQUILIBRIUM PSYCHOLOGICAL SERVICES LLC

Table of content: (NPI 1780424622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780424622 NPI number — EQUILIBRIUM PSYCHOLOGICAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EQUILIBRIUM PSYCHOLOGICAL SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780424622
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB. BRISAS DE EVELYMAR
Provider Second Line Business Mailing Address:
1005 CALLE CORAL
Provider Business Mailing Address City Name:
SALINAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00751-1400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-486-7149
Provider Business Mailing Address Fax Number:
787-824-7149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. PR-1 K, 77.9 BO. LAPA SECTOR PARCELAS VAZQUEZ
Provider Second Line Business Practice Location Address:
# 480
Provider Business Practice Location Address City Name:
SALINAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-486-7149
Provider Business Practice Location Address Fax Number:
787-824-7149
Provider Enumeration Date:
05/29/2024

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
MARLA
Authorized Official Middle Name:
RIVERA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-486-7149

Provider Taxonomy Codes

  • Taxonomy code: 103TH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com