Healthcare Provider Details

I. General information

NPI: 1063234565
Provider Name (Legal Business Name): RELEASE PSYCHOLOGY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 CALLE ANDRES ARUS RIVERA W
GURABO PR
00778-2321
US

IV. Provider business mailing address

41 HACIENDA PARQUE
SAN LORENZO PR
00754-9633
US

V. Phone/Fax

Practice location:
  • Phone: 939-891-0533
  • Fax:
Mailing address:
  • Phone: 939-891-0533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KARLA BAEZ RIOS
Title or Position: PSYCHOLOGIST
Credential:
Phone: 939-891-0533