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Organization
BRAIN BASE THERAPY CENTER LLC
Active
Organization
BRAIN BASE THERAPY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIZA ROBELY RODRIGUEZ THL, CPETE, CNSL (PRESIDENTA)
(787) 202-5530
Entity
Organization
Contact information
Practice address
BARRIO LOS LLANOS, CARRETERA #14, KM 26.7, COAMO, PR 00769
(787) 202-5530
Mailing address
URB. COLINAS DE VERDE AZUL CALLE SIENA, # 46, JUANA DIAZ, PR 00795
(787) 202-5530
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261Q00000X
Clinic/Center
—
—
261QH0700X
Hearing and Speech Clinic/Center
Primary
—
—
Other
Enumeration date
03/11/2020
Last updated
11/07/2020
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