Healthcare Provider Details

I. General information

NPI: 1053242453
Provider Name (Legal Business Name): SERVICIOS INTERDISCIPLINARIOS DE BIENESTAR MENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 BLVD LUIS A FERRE
PONCE PR
00717-2113
US

IV. Provider business mailing address

17 CALLE MONSERRATE
COTO LAUREL PR
00780-2466
US

V. Phone/Fax

Practice location:
  • Phone: 787-231-5676
  • Fax:
Mailing address:
  • Phone: 787-298-7525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE DANIEL GUADALUPE
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 787-231-5676