=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437011871
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MENTE CLARA CENTRO PSICOLOGICO PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2025
-----------------------------------------------------
Last Update Date | 11/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | EDIFICIO LA CURVA PROFESSIONAL PLAZA AVE MILITAR 3081 SUITE 201
-----------------------------------------------------
City | ISABELA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-373-7155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | E2 JARD MARIBEL
-----------------------------------------------------
City | AGUADILLA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00603-5603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-373-7155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSICOLOGIST
-----------------------------------------------------
Name | VANESSA MARIA PORTILLA
-----------------------------------------------------
Credential | M.A.
-----------------------------------------------------
Telephone | 939-224-0214
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------