Healthcare Provider Details

I. General information

NPI: 1649038431
Provider Name (Legal Business Name): MINDSPEAK PSYCHOLOGICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB SANTA JUANITA AVE SANTA JUANITA P62 LOCAL B
BAYAMON PR
00956
US

IV. Provider business mailing address

PO BOX 3521
BAYAMON PR
00958-0521
US

V. Phone/Fax

Practice location:
  • Phone: 939-297-3266
  • Fax:
Mailing address:
  • Phone: 939-297-3266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/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 Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YESSENIA ROSADO
Title or Position: PRESIDENT
Credential: MA
Phone: 939-297-3266