MEDICARE: MINDSPACE PSYCHOLOGICAL CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1356295059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDSPACE PSYCHOLOGICAL CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 7233
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-7233
Country	:	US
Telephone Number	:	787-436-2242
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 CALLE BALDORIOTY
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-3605
Country	:	US
Telephone Number	:	787-436-2242
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. MIGUEL L. NERIS-RODRIGUEZ SR.
Credential	:	PHD
Telephone Number	:	787-436-2242

Provider Enumeration Date	:	02/21/2026
Last Update Date	:	02/21/2026

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