Healthcare Provider Details

I. General information

NPI: 1811377849
Provider Name (Legal Business Name): MINDS MENTAL & BEHAVIORAL CENTER, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 CARR 20 SUITE 301 CORP OFFICE PARK
GUAYNABO PR
00966
US

IV. Provider business mailing address

PO BOX 7891 PMB 349
GUAYNABO PR
00970-7891
US

V. Phone/Fax

Practice location:
  • Phone: 787-593-7082
  • Fax:
Mailing address:
  • Phone: 787-593-7082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number2142
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VIMARY RODRIGUEZ
Title or Position: PRESIDENT
Credential: PSYD
Phone: 787-593-7082