Provider Demographics
NPI:1659077295
Name:PSYCHOLOGICAL WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-246-2827
Mailing Address - Street 1:PO BOX 3372
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-3372
Mailing Address - Country:US
Mailing Address - Phone:787-246-2728
Mailing Address - Fax:
Practice Address - Street 1:CARR.PR-54 INT. RAMAL 7711
Practice Address - Street 2:BO. POZO HONDO
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-246-2827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4519251OtherDRIVER LICENSE