Provider Demographics
NPI:1942502968
Name:PSYCH WELLNESS CENTER PSC
Entity Type:Organization
Organization Name:PSYCH WELLNESS CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGY/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:RODRIGUEZ
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-392-9990
Mailing Address - Street 1:453 CALLE CESAR GONZALEZ
Mailing Address - Street 2:OFICINA 6
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2638
Mailing Address - Country:US
Mailing Address - Phone:787-392-9990
Mailing Address - Fax:
Practice Address - Street 1:453 CALLE CESAR GONZALEZ
Practice Address - Street 2:OFICINA 6
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2638
Practice Address - Country:US
Practice Address - Phone:787-392-9990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3348261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)