Healthcare Provider Details

I. General information

NPI: 1871207704
Provider Name (Legal Business Name): MINDSET THERAPY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA NATIVA ALERS BARRIO PIEDRAS BLANCAS SECTOR DESVIO SUR 108L
AGUADA PR
00602
US

IV. Provider business mailing address

AVENIDA NATIVA ALERS BARRIO PIEDRAS BLANCAS SECTOR DESVIO SUR 108L
AGUADA PR
00602
US

V. Phone/Fax

Practice location:
  • Phone: 787-692-4595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE D RAMIREZ CRUZ
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 787-692-4595