| Psylab Llc | |
|
Urb. Tomas Carrion Maduro 49 Calle 4 Juana Diaz PR 00795 | |
| (787) 553-0895 | |
| Not Available |
| Full Name | Psylab Llc |
|---|---|
| Speciality | Psychologist |
| Location | Urb. Tomas Carrion Maduro, Juana Diaz, Puerto Rico |
| Authorized Official Name and Position | Camille Colon Camacho (PRESIDENT/DIRECTOR) |
| Authorized Official Contact | 7873240223 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psylab Llc 104 Calle Cedro Est De Juana Diaz Juana Diaz PR 00795 Ph: (787) 324-0223 | Psylab Llc Urb. Tomas Carrion Maduro 49 Calle 4 Juana Diaz PR 00795 Ph: (787) 553-0895 |
| NPI Number | 1750117883 |
|---|---|
| Provider Enumeration Date | 09/13/2024 |
| Last Update Date | 09/13/2024 |
| Certification Date | 09/13/2024 |
| Medicare PECOS PAC ID | 3577099639 |
|---|---|
| Medicare Enrollment ID | O20241212000991 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750117883 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Primary |
| Provider Name | Camille Marie Colon |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1346973633 PECOS PAC ID: 4486180544 Enrollment ID: I20241212001082 |
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