Provider Demographics
NPI:1437011871
Name:MENTE CLARA CENTRO PSICOLOGICO PSC
Entity type:Organization
Organization Name:MENTE CLARA CENTRO PSICOLOGICO PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSICOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:PORTILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:939-224-0214
Mailing Address - Street 1:E2 JARD MARIBEL
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5603
Mailing Address - Country:US
Mailing Address - Phone:787-373-7155
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO LA CURVA PROFESSIONAL PLAZA AVE MILITAR 3081
Practice Address - Street 2:SUITE 201
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-373-7155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty