Healthcare Provider Details

I. General information

NPI: 1619693165
Provider Name (Legal Business Name): BEHAVIORAL HEALTH SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 AVE. FONT MARTELO OFICINAS MEDICAS MENONITA
HUMACAO PR
00791-0072
US

IV. Provider business mailing address

URB. SUNRISE 78 TWILIGHT ST
HUMACAO PR
00791
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-0505
  • Fax:
Mailing address:
  • Phone: 787-640-5488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANTONIO RIVERA SANTIAGO
Title or Position: OWNER/PSYCHOLOGIST
Credential:
Phone: 787-640-5488