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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