Healthcare Provider Details

I. General information

NPI: 1437011871
Provider Name (Legal Business Name): MENTE CLARA CENTRO PSICOLOGICO PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIFICIO LA CURVA PROFESSIONAL PLAZA AVE MILITAR 3081 SUITE 201
ISABELA PR
00662
US

IV. Provider business mailing address

E2 JARD MARIBEL
AGUADILLA PR
00603-5603
US

V. Phone/Fax

Practice location:
  • Phone: 787-373-7155
  • Fax:
Mailing address:
  • Phone: 787-373-7155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: VANESSA MARIA PORTILLA
Title or Position: PSICOLOGIST
Credential: M.A.
Phone: 939-224-0214