| Centro Psicologico Ilo, Inc. | |
|
Ave Degetau # Ad7 13 Calle Hormigueros Caguas PR 00725-5819 | |
| (787) 930-3144 | |
| Not Available |
| Full Name | Centro Psicologico Ilo, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | Ave Degetau # Ad7, Caguas, Puerto Rico |
| Authorized Official Name and Position | Ivelisse Lopez (PSICOLOGA CLINICA) |
| Authorized Official Contact | 7876728096 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centro Psicologico Ilo, Inc. Calle Rubi Villa Blanca #31 Caguas PR 00725-1933 Ph: (787) 672-8096 | Centro Psicologico Ilo, Inc. Ave Degetau # Ad7 13 Calle Hormigueros Caguas PR 00725-5819 Ph: (787) 930-3144 |
| NPI Number | 1902239114 |
|---|---|
| Provider Enumeration Date | 08/12/2013 |
| Last Update Date | 09/19/2024 |
| Certification Date | 09/19/2024 |
| Medicare PECOS PAC ID | 6103146923 |
|---|---|
| Medicare Enrollment ID | O20150519001719 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902239114 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Carlos A Colon |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760803175 PECOS PAC ID: 2264651215 Enrollment ID: I20140924000844 |
| Provider Name | Ivelisse Lopez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1215281639 PECOS PAC ID: 3971823790 Enrollment ID: I20200108000624 |
| Provider Name | Jeamy Liz Santos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720760093 PECOS PAC ID: 1658710926 Enrollment ID: I20240418004123 |
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