Healthcare Provider Details

I. General information

NPI: 1538929682
Provider Name (Legal Business Name): ARLYN BRUNET RODRIGUEZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/19/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

D1 CALLE PARKSIDE #5 APT 7B
GUAYNABO PR
00968
US

IV. Provider business mailing address

138 WINSTON CHURCHILL AVE. PMB 627
SAN JUAN, PR PR
00926-6013
US

V. Phone/Fax

Practice location:
  • Phone: 571-459-0104
  • Fax:
Mailing address:
  • Phone: 571-459-0104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number2728
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2728
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2728
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number2728
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number2728
License Number StatePR
# 7
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2728
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: