Provider Demographics
| NPI: | 1508354705 |
|---|---|
| Name: | RR PSYCH PSC |
| Entity Type: | Organization |
| Organization Name: | RR PSYCH PSC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | ADMINISTRATOR |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | DENNIS |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | RIOS ROMAN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 787-612-7997 |
| Mailing Address - Street 1: | 42 CALLE CAONABO |
| Mailing Address - Street 2: | URB CIUDAD JARDIN |
| Mailing Address - City: | JUNCOS |
| Mailing Address - State: | PR |
| Mailing Address - Zip Code: | 00777 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 787-376-6247 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | CARR 173 KM 6.3 |
| Practice Address - Street 2: | BARRIO RABANAL SECTOR SAN JOSE |
| Practice Address - City: | CIDRA |
| Practice Address - State: | PR |
| Practice Address - Zip Code: | 00739 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 787-376-6247 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | RR PSYCH PSC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2018-04-24 |
| Last Update Date: | 2018-04-24 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
| No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
| No | 103TH0004X | Behavioral Health & Social Service Providers | Psychologist | Health | Group - Multi-Specialty |
| No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
| No | 103TP0016X | Behavioral Health & Social Service Providers | Psychologist | Prescribing (Medical) | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
