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General NPI Number Information
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NPI Number | 1811377849
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Entity Type | Organization
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Legal Business Name | MINDS MENTAL & BEHAVIORAL CENTER, PSC
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 09/28/2015
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Provider Practice Location Address
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Address Line | 36 CARR 20 SUITE 301 CORP OFFICE PARK
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City | GUAYNABO
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State | PR
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Zip | 00966
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Country | US
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Telephone | 787-593-7082
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7891 PMB 349
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City | GUAYNABO
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State | PR
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Zip | 00970-7891
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Country | US
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Telephone | 787-593-7082
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VIMARY RODRIGUEZ
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Credential | PSYD
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Telephone | 787-593-7082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 2142
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License Number State | PR
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