1093973596 NPI number — INTEGRATIVE PSYCHOLOGICAL SERVICES FOR THE FAMILY

Table of content: (NPI 1093973596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093973596 NPI number — INTEGRATIVE PSYCHOLOGICAL SERVICES FOR THE FAMILY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATIVE PSYCHOLOGICAL SERVICES FOR THE FAMILY
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:
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:
1093973596
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
165 PUEBLO VIEJO TORRE 1 SUITE 401
Provider Second Line Business Mailing Address:
CENTRO INTERNACIONAL DE MERCADEO
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-460-3031
Provider Business Mailing Address Fax Number:
787-279-1708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PALACIOS DE MARBELLA # 1147
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOA ALTA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-218-5002
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MATOS
Authorized Official First Name:
LORRAINE
Authorized Official Middle Name:
PIERALDI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-460-3031

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  2781 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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