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General NPI Number Information
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NPI Number | 1851101935
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Entity Type | Organization
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Legal Business Name | ISLAND THERAPY COLLECTIVE LLC
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 231 CALLE AMAPOLA
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City | SAN GERMAN
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State | PR
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Zip | 00683-9011
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Country | US
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Telephone | 787-432-8085
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Fax |
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Provider Business Mailing Address
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Address Line | 231 CALLE AMAPOLA
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City | SAN GERMAN
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State | PR
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Zip | 00683-9011
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Country | US
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Telephone | 787-432-9085
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | JAVIER ROBLEDO RIVERA
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Credential | PSYD
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Telephone | 787-432-9085
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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 |
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License Number State |
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Taxonomy #2
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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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