Healthcare Provider Details

I. General information

NPI: 1114676376
Provider Name (Legal Business Name): EMOTIONAL CONNECT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 CALLE 2 STE 520
GUAYNABO PR
00968-1750
US

IV. Provider business mailing address

17 CALLE 2 STE 520
GUAYNABO PR
00968-1750
US

V. Phone/Fax

Practice location:
  • Phone: 787-622-9797
  • Fax: 787-622-9888
Mailing address:
  • Phone: 787-622-9797
  • Fax: 787-622-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. AWILDA M BROCO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 787-622-9797