Healthcare Provider Details

I. General information

NPI: 1861312209
Provider Name (Legal Business Name): MIDNIGHT PSYCHOLOGY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB SANTA CLARA C10
GUANICA PR
00653
US

IV. Provider business mailing address

URB SANTA CLARA C10
GUANICA PR
00653
US

V. Phone/Fax

Practice location:
  • Phone: 939-459-0938
  • Fax:
Mailing address:
  • Phone: --
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. VICTOR JOSUE VIVAS LOPEZ
Title or Position: CLINICAL PSYCHOLOGIST/PRESIDENT
Credential: PSYD
Phone: --