Healthcare Provider Details

I. General information

NPI: 1295656668
Provider Name (Legal Business Name): LUMERA PSYCHOLOGICAL & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 R 638 KM 5.3 INT BO MIRAFLORES SCT PALACHE
ARECIBO PR
00616-0000
US

IV. Provider business mailing address

HC 2 BOX 5610
BAJADERO PR
00616-9789
US

V. Phone/Fax

Practice location:
  • Phone: 787-428-7744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: CARMEN G GONZALEZ
Title or Position: PRESIDENTA
Credential:
Phone: 787-428-7744