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General NPI Number Information
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NPI Number | 1811813090
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Entity Type | Organization
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Legal Business Name | MINDWELL PSYCHOLOGY CLINIC
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Dates
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Enumeration Date | 06/24/2026
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Last Update Date | 06/24/2026
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Provider Practice Location Address
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Address Line | AVENIDA MUNOZ RIVERA URB MARIANI 1583 LOCAL 2
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City | PONCE
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State | PR
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Zip | 00717
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Country | US
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Telephone | 787-905-5216
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Fax |
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Provider Business Mailing Address
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Address Line | 202 CALLE PRINCIPE
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City | COTO LAUREL
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State | PR
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Zip | 00780-3211
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Country | US
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Telephone | 787-905-5216
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Fax |
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Authorized Official
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Title or Position | PSICOLOGA
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Name | DR. JELISSE MATOS
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Credential | PSYD
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Telephone | 787-905-5216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #11
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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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