Healthcare Provider Details

I. General information

NPI: 1861203382
Provider Name (Legal Business Name): MINDBLOOM PSYCHOLOGICAL CENTER, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 QUADRANGEL MEDICAL BUILDING AVE LUIS MUNOZ MARIN
CAGUAS PR
00725
US

IV. Provider business mailing address

2T-50 CALLE 30 MIRADOR DE BAIROA
CAGUAS PR
00727-1002
US

V. Phone/Fax

Practice location:
  • Phone: 787-595-6085
  • Fax:
Mailing address:
  • Phone: 787-595-6085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. GABRIELA MARIA GUTIERREZ
Title or Position: PRESIDENT
Credential: PSYD
Phone: 787-595-6085