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General NPI Number Information
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NPI Number | 1861203382
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Entity Type | Organization
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Legal Business Name | MINDBLOOM PSYCHOLOGICAL CENTER, LLC.
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 305 QUADRANGEL MEDICAL BUILDING AVE LUIS MUNOZ MARIN
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-595-6085
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Fax |
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Provider Business Mailing Address
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Address Line | 2T-50 CALLE 30 MIRADOR DE BAIROA
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City | CAGUAS
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State | PR
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Zip | 00727-1002
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Country | US
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Telephone | 787-595-6085
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. GABRIELA MARIA GUTIERREZ
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Credential | PSYD
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Telephone | 787-595-6085
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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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