Provider Demographics
NPI:1861158156
Name:CENTRO PSICOTERAPEUTICO INTEGRADO SINERGIA
Entity type:Organization
Organization Name:CENTRO PSICOTERAPEUTICO INTEGRADO SINERGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINGO
Authorized Official - Middle Name:L
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:787-557-2677
Mailing Address - Street 1:URB EL DORADO CALLE JAZMIN A6-A7
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-557-2677
Mailing Address - Fax:
Practice Address - Street 1:AVE. LOS VETERANOS KM 136.7
Practice Address - Street 2:URB. VILLA ROSA 3, A23 LOCAL 2 (FRENTE A CENTRICO)
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-557-2677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-11
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health