Healthcare Provider Details

I. General information

NPI: 1629990031
Provider Name (Legal Business Name): RAICES CENTRO PSICOLOGICO Y DE BIENESTAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 189 KM 2.8
CAGUAS PR
00725
US

IV. Provider business mailing address

HC 3 BOX 33851
HATILLO PR
00659-7857
US

V. Phone/Fax

Practice location:
  • Phone: 939-263-3487
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MARLIN ALICEA FERNANDEZ
Title or Position: OWNER/PSYCHOLOGIST
Credential: PSYD
Phone: 939-263-3487