Healthcare Provider Details

I. General information

NPI: 1285427278
Provider Name (Legal Business Name): PROFESSIONAL CONSULTING PSYCHOEDUCATIONAL SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 AVE PONCE DE LEON SUITE 500 EDIFICIO TELESFORO ESQ CERRA
SAN JUAN PR
00907
US

IV. Provider business mailing address

405 AVE ESMERALDA STE 2
GUAYNABO PR
00969-4466
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-2665
  • Fax:
Mailing address:
  • Phone: 787-644-9872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERTO DE JESUS
Title or Position: PRESIDENT
Credential: PH. D
Phone: 787-644-9872