Provider Demographics
NPI:1730503541
Name:CREATIVE THERAPY CENTER, CSP
Entity type:Organization
Organization Name:CREATIVE THERAPY CENTER, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-637-1159
Mailing Address - Street 1:PO BOX 4193
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00958-1193
Mailing Address - Country:US
Mailing Address - Phone:787-637-1159
Mailing Address - Fax:787-545-4246
Practice Address - Street 1:CARR 167
Practice Address - Street 2:MARGINAL BUENA VISTA U-1
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-4477
Practice Address - Country:US
Practice Address - Phone:787-637-1159
Practice Address - Fax:787-545-4246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2286261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center