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General NPI Number Information
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NPI Number | 1942502968
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Entity Type | Organization
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Legal Business Name | PSYCH WELLNESS CENTER PSC
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 453 CALLE CESAR GONZALEZ OFICINA 6
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City | SAN JUAN
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State | PR
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Zip | 00918-2638
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Country | US
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Telephone | 787-392-9990
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Fax |
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Provider Business Mailing Address
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Address Line | 453 CALLE CESAR GONZALEZ OFICINA 6
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City | SAN JUAN
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State | PR
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Zip | 00918-2638
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Country | US
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Telephone | 787-392-9990
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGY/PRESIDENT
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Name | DR. AMELIA RODRIGUEZ ACEVEDO
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Credential | PHD
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Telephone | 787-392-9990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 3348
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License Number State | PR
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