Healthcare Provider Details

I. General information

NPI: 1194383109
Provider Name (Legal Business Name): QUALITY MENTAL HEALTH & EDUCATIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 SANTANA
ARECIBO PR
00612-6708
US

IV. Provider business mailing address

513 SANTANA
ARECIBO PR
00612-6708
US

V. Phone/Fax

Practice location:
  • Phone: 787-356-5376
  • Fax:
Mailing address:
  • Phone: 787-356-5376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. RAMONITA DIAZ JIMENEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-356-5376