Healthcare Provider Details

I. General information

NPI: 1083023774
Provider Name (Legal Business Name): HAPPY BRAINS PSYCHOLOGY, THERAPY & LEARNING CENTER CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BK 10 AVENIDA LAS AMERICAS URBANIZACION BAIROA
CAGUAS PR
00725
US

IV. Provider business mailing address

PO BOX 429
GURABO PR
00778-0429
US

V. Phone/Fax

Practice location:
  • Phone: 787-900-3983
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: NILMARIE MATOS FRADERA
Title or Position: CO OWNER
Credential: LCDA.
Phone: 787-598-7631