| NPI | 1346593639 |
|---|---|
| Doing Business As | SOLE PROPIERTOR |
| Entity Type | Organization |
| Authorized Contact | LESBIA BETANCOURT Clinical Social Work/Clinician 787-963-0171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X (Licence: PR 3906) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: PR 3906) |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2012-10-24 |