Healthcare Provider Details

I. General information

NPI: 1295991578
Provider Name (Legal Business Name): BERNARDO ROQUE PSY.D, HCT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 11/05/2024
Certification Date: 11/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 198 KM 22.0 BO. MONTONES I
LAS PIEDRAS PR
00791-0198
US

IV. Provider business mailing address

URB. ALTURAS DE SAN BENITO CALLE REINA DE LA PAZ 11
HUMACAO PR
00791-9202
US

V. Phone/Fax

Practice location:
  • Phone: 787-716-0050
  • Fax:
Mailing address:
  • Phone: 787-645-2587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3156
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8072
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3156
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: