Healthcare Provider Details

I. General information

NPI: 1902541758
Provider Name (Legal Business Name): BEAUTIFUL MIND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/11/2025
Certification Date: 05/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. RAFAEL COLON CASTRO #3, URB. RADIOVILLE SUITE 2
ARECIBO PR
00612
US

IV. Provider business mailing address

HC 1 BOX 8054
HATILLO PR
00659-7360
US

V. Phone/Fax

Practice location:
  • Phone: 939-649-9689
  • Fax:
Mailing address:
  • Phone: 939-244-7013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD NIEVES HERNANDEZ
Title or Position: PRESIDENTE
Credential: PSY.D
Phone: 939-244-7013