Provider Demographics
NPI:1205565660
Name:CLINICA DE SERVICIOS PSICOLOGICOS DESPERTAR LLC
Entity type:Organization
Organization Name:CLINICA DE SERVICIOS PSICOLOGICOS DESPERTAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:Z
Authorized Official - Last Name:QUINONES SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:787-528-8175
Mailing Address - Street 1:20 AVE LUIS MUNOZ MARIN PMB 349
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-1956
Mailing Address - Country:US
Mailing Address - Phone:787-639-8894
Mailing Address - Fax:
Practice Address - Street 1:TORRE MEDICA SAN PABLO PISO 5
Practice Address - Street 2:SUITE 504
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3998
Practice Address - Country:US
Practice Address - Phone:787-639-8894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty