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General NPI Number Information
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NPI Number | 1487161808
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Entity Type | Organization
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Legal Business Name | MENTE RENOVADA CENTRO DE INTERVENCION CLINICA SOCIAL
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | BUEN SAMARITANO MEDICAL & PROFESSIONAL PLAZA TERCER PISO SUITE #11
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City | AGUADILLA
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State | PR
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Zip | 00603
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Country | US
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Telephone | 787-422-2595
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Fax |
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Provider Business Mailing Address
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Address Line | 219 CALLE A
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City | AGUADA
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State | PR
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Zip | 00602-4007
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Country | US
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Telephone | 787-669-5124
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Fax |
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Authorized Official
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Title or Position | TRABAJADORA SOCIAL CLINICA
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Name | MRS. MARIAN DESARDEN
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Credential | LICENCIADA
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Telephone | 787-422-2595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 10474
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License Number State | PR
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