Healthcare Provider Details

I. General information

NPI: 1912419284
Provider Name (Legal Business Name): JONATHAN ECHEVARRIA PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. CUPEY GARDENS #200 LOTE 3 PLAZA CUPEY GARDENS
SAN JUAN PR
00926
US

IV. Provider business mailing address

HC 645 BOX 6387
TRUJILLO ALTO PR
00976-9746
US

V. Phone/Fax

Practice location:
  • Phone: 787-292-0205
  • Fax:
Mailing address:
  • Phone: 787-292-0205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number5921
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5921
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number5921
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: