Healthcare Provider Details

I. General information

NPI: 1306686936
Provider Name (Legal Business Name): MME PSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE MUNOZ RIVERA 53 ESTE SUITE 4
CAMUY PR
00627
US

IV. Provider business mailing address

24118 CALLE MILENIO
QUEBRADILLAS PR
00678-7274
US

V. Phone/Fax

Practice location:
  • Phone: 787-361-4911
  • Fax:
Mailing address:
  • Phone: 787-361-4911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARYANN RAMOS HERNANDEZ
Title or Position: TESORERA
Credential: PSYD
Phone: 787-361-4911