Organization
CENTRO DE LA TERCERA ONDA,CSP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHLEEN KELLY PHD (DIRECTOR)
(787) 636-4958
Entity
Organization
Contact information
Practice address
100 AMAZONA, URB EL PARAISO, PISO 2, SAN JUAN, PR 00926
(787) 510-9032
Mailing address
100 AMAZONA, URB EL PARAISO, PISO 2, SAN JUAN, PR 00926
(787) 510-9032
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3891
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013241512
NPI
—
Enumeration date
09/25/2014
Last updated
07/21/2022
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