Healthcare Provider Details

I. General information

NPI: 1841625225
Provider Name (Legal Business Name): PSICONSULTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 09/02/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112. CALLE ARZUAGA SUITE 802
SAN JUAN PR
00925-3318
US

IV. Provider business mailing address

P.O. BOX 21352
SAN JUAN PR
00931-1352
US

V. Phone/Fax

Practice location:
  • Phone: 939-437-0553
  • Fax:
Mailing address:
  • Phone: 939-437-0553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number4339
License Number StatePR

VIII. Authorized Official

Name: MALVALIZ SANTANA CARRASQUILLO
Title or Position: PRESIDENT/PSYCHOLOGIST
Credential: PHD
Phone: 939-437-0553