Healthcare Provider Details

I. General information

NPI: 1144006529
Provider Name (Legal Business Name): EZEQUIEL MAISONET MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MINDFUL HEALING PSYCHOTHERAPY CLINIC LLC AGUADA COMPLEX SUITE 5 CARR 115 KM 24.5 BO ASOMANTE
AGUADA PR
00602
US

IV. Provider business mailing address

PO BOX 5000 SUITE 946
AGUADA PR
00602-7003
US

V. Phone/Fax

Practice location:
  • Phone: 787-487-9086
  • Fax:
Mailing address:
  • Phone: 787-438-4823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8765
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: