Healthcare Provider Details

I. General information

NPI: 1851101935
Provider Name (Legal Business Name): ISLAND THERAPY COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 CALLE AMAPOLA
SAN GERMAN PR
00683-9011
US

IV. Provider business mailing address

231 CALLE AMAPOLA
SAN GERMAN PR
00683-9011
US

V. Phone/Fax

Practice location:
  • Phone: 787-432-8085
  • Fax:
Mailing address:
  • Phone: 787-432-9085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAVIER ROBLEDO RIVERA
Title or Position: CLINICAL DIRECTOR
Credential: PSYD
Phone: 787-432-9085