Healthcare Provider Details

I. General information

NPI: 1346931706
Provider Name (Legal Business Name): NEUROEDUCATIONAL CONSULTANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO TIERRA SANTA CARR 149 KM 582 PRIMER PISO
VILLALBA PR
00766
US

IV. Provider business mailing address

BO TIERRA SANTA CARR 149 KM 582 PRIMER PISO
VILLALBA PR
00766
US

V. Phone/Fax

Practice location:
  • Phone: 787-517-9493
  • Fax:
Mailing address:
  • Phone: 787-517-9493
  • 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 Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JOAN MARIE ACOSTA NEGRON
Title or Position: PRESIDENT/ OWNER
Credential: PSYCHOLOGIST
Phone: 787-517-9493