Healthcare Provider Details

I. General information

NPI: 1962329409
Provider Name (Legal Business Name): EMANUEL CONCEPCION MPSY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 527
BAJADERO PR
00616-0527
US

IV. Provider business mailing address

PO BOX 527
BAJADERO PR
00616-0527
US

V. Phone/Fax

Practice location:
  • Phone: 787-383-9271
  • Fax:
Mailing address:
  • Phone: 787-383-9271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number9006
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: