Centro de la Tercera Onda,CSP.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3891 Issued in PR

Legal business name

CENTRO DE LA TERCERA ONDA,CSP.

Practice address

100 Amazona
Urb El Paraiso, Piso 2
San Juan, PR 00926

Phone

(787) 510-9032

NPI assigned

Sep 25, 2014

Last updated

Jul 21, 2022By 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. Kathleen Kelly, PHD

Title

Director

Phone

(787) 636-4958

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1411603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1841692415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 AMAZONA",
            "address_2": "URB EL PARAISO, PISO 2",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00926",
            "telephone_number": "787-510-9032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 AMAZONA",
            "address_2": "URB EL PARAISO, PISO 2",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00926",
            "telephone_number": "787-510-9032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRO DE LA TERCERA ONDA,CSP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-25",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "787-636-4958",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "PR",
            "license": "3891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1013241512",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in San Juan, PR
• Providers in San Juan, PR by specialty
• Clinical Psychologist in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.