MEDICARE: MIND GROWTH CLINIC

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	103TH0100X	Health Service Psychologist

General Provider Information

NPI Number	:	1740131689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND GROWTH CLINIC

Provider Business Mailing Address
First Line	:	28 CALLE 1 APT 4B
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00969-3320
Country	:	US
Telephone Number	:	787-413-4429
Fax Number	:

Provider Business Practice Location Address
First Line	:	1451 AVE ASHFORD
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1511
Country	:	US
Telephone Number	:	787-413-4429
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER/OWNER
Name	:	MISS JOCELYN MORELL CASELLAS
Credential	:	M. PSY.
Telephone Number	:	787-413-4429

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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