Healthcare Provider Details

I. General information

NPI: 1760018204
Provider Name (Legal Business Name): BEWELL PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CC10 CALLE DR JOSE SABATER
TOA BAJA PR
00949-3335
US

IV. Provider business mailing address

CC10 CALLE DR JOSE SABATER
TOA BAJA PR
00949-3335
US

V. Phone/Fax

Practice location:
  • Phone: 787-399-9438
  • Fax:
Mailing address:
  • Phone: 787-399-9438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ORLANDO SANCHEZ
Title or Position: PSYCHOLOGIST
Credential: M.A.
Phone: 787-399-9438