Psicologos Clinicos del Santurce Medical Mall, CSP

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

1165 Issued in PR

Legal business name

PSICOLOGOS CLINICOS DEL SANTURCE MEDICAL MALL, CSP

Practice address

1801 Ave Ponce de Leon
Suite 311
San Juan, PR 00909-1900

Phone

(787) 727-2424

Fax

(787) 727-2424

NPI assigned

Jun 21, 2011

Last updated

Jun 21, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Maria Elizabeth Chavez, PH.D.

Title

President

Phone

(787) 727-2424

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308614400000",
    "number": "1093001729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 AVE PONCE DE LEON",
            "address_2": "SUITE 311",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009091900",
            "telephone_number": "787-727-2424",
            "fax_number": "787-727-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 AVE PONCE DE LEON",
            "address_2": "SUITE 311",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009091900",
            "telephone_number": "787-727-2424",
            "fax_number": "787-727-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSICOLOGOS CLINICOS DEL SANTURCE MEDICAL MALL, CSP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-21",
        "last_updated": "2011-06-21",
        "status": "A",
        "authorized_official_last_name": "CHAVEZ",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-727-2424",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "PR",
            "license": "1165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prspi, PSC (Puerto Rico Sports and Pain Medicine Institute)
• Prspine LLC
• Psico Group de PR Inc (PSYCOmax)
• Psico-Colectivo, LLC
• Psicologia Avanzada Diaz
• Psiconsulta
• Psych Wellness Center PSC
• Psych Wellness Corporation
• Psychiatry Parnters
• Psychiatry Wellness Group

• Mental Health Clinic/Center (Including Community Mental Health Center) in San Juan, PR
• Providers in San Juan, PR by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.