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General NPI Number Information
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NPI Number | 1497637706
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Entity Type | Organization
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Legal Business Name | EBAO MENTAL HEALTH CLINIC, LLC.
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Dates
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Enumeration Date | 07/25/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 65 AVE BARBOSA STE 103
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City | ARECIBO
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State | PR
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Zip | 00612-2746
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Country | US
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Telephone | 939-263-3462
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Fax |
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Provider Business Mailing Address
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Address Line | 65 AVE BARBOSA STE 103
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City | ARECIBO
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State | PR
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Zip | 00612-2746
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Country | US
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Telephone | 939-263-3462
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWIN ALONSO OLMO
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Credential | MA
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Telephone | 787-944-5516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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