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NPI Code Detail

MEDICARE: GREISTAR MENTAL & PHYSICAL HEALTH, LLC

MEDICARE: GREISTAR MENTAL & PHYSICAL HEALTH, 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
1103G00000XClinical Neuropsychologist
2103T00000XPsychologist
3103TB0200XCognitive & Behavioral Psychologist
4103TC0700XClinical Psychologist
5103TC2200XClinical Child & Adolescent Psychologist
6103TF0000XFamily Psychologist
7103TH0004XHealth Psychologist
8103TH0100XHealth Service Psychologist
9103TP0016XPrescribing (Medical) Psychologist
10103TR0400XRehabilitation Psychologist
11104100000XSocial Worker
12106E00000XAssistant Behavior Analyst
13103TP2701XGroup Psychotherapy Psychologist

General Provider Information

NPI Number : 1942738570
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREISTAR MENTAL & PHYSICAL HEALTH, LLC
Provider Business Mailing Address
First Line : 1226 CALLE CADIZ
Second Line : URB. PUERTO NUEVO
City : SAN JUAN
State : PR
Zip : 00920
Country : US
Telephone Number : 787-985-0891
Fax Number : 787-985-0892
Provider Business Practice Location Address
First Line : 1226 CALLE CADIZ
Second Line : URB. PUERTO NUEVO
City : SAN JUAN
State : PR
Zip : 00920-3841
Country : US
Telephone Number : 787-985-0891
Fax Number : 787-985-0892
Authorized Official
Title or Position : PRESIDENT
Name : DR. GRISELLE GARCIA HERNANDEZ
Credential :
Telephone Number : 787-374-5801
Provider Enumeration Date : 05/26/2017
Last Update Date : 05/26/2017

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Directions to “GREISTAR MENTAL & PHYSICAL HEALTH, LLC ” Practice Location

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