Healthcare Provider Details

I. General information

NPI: 1487774923
Provider Name (Legal Business Name): TOMAS MAUNEZ IV M.ED. LPC, RN-BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALLE L-16 DIPLO
NAGUABO PR
00718-0787
US

IV. Provider business mailing address

PO BOX 787
NAGUABO PR
00718-0787
US

V. Phone/Fax

Practice location:
  • Phone: 787-310-2039
  • Fax:
Mailing address:
  • Phone: 787-310-2039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number76444G
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StatePR
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1163
License Number StatePR
# 7
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StatePR
# 8
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number76444G
License Number StatePR
# 9
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number76444G
License Number StatePR
# 10
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number76444G
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: