Healthcare Provider Details

I. General information

NPI: 1427965649
Provider Name (Legal Business Name): PHOENIX PSYCHOLOGICAL CARE AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO LOMAS VALLES CARR 8811 KM 0.2
NARANJITO PR
00719
US

IV. Provider business mailing address

HC 1 BOX 3331
COROZAL PR
00783-9422
US

V. Phone/Fax

Practice location:
  • Phone: 787-619-3410
  • Fax:
Mailing address:
  • Phone: 787-619-3410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TAIMARA ORTIZ
Title or Position: PRESIDENT
Credential: PH.D
Phone: 787-619-3410