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General NPI Number Information
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NPI Number | 1801656020
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Entity Type | Organization
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Legal Business Name | MINDFUL HEALING PSYCHOTHERAPY CLINIC
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Dates
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Enumeration Date | 03/22/2024
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Last Update Date | 03/22/2024
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Provider Practice Location Address
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Address Line | AGUADA COMPLEX SUITE 5 CARRETERA 115
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City | AGUADA
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State | PR
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Zip | 00602
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Country | US
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Telephone | 787-487-9086
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Fax |
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Provider Business Mailing Address
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Address Line | URB FLAMBOYANES 39
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City | AGUADA
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State | PR
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Zip | 00602
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Country | US
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Telephone | 787-487-9086
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Fax |
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Authorized Official
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Title or Position | PSCOLOGY
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Name | ANA CONCEPCION CARRERO
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Credential | DRA
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Telephone | 787-487-9086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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