Provider Demographics
NPI:1497637706
Name:EBAO MENTAL HEALTH CLINIC, LLC.
Entity type:Organization
Organization Name:EBAO MENTAL HEALTH CLINIC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALONSO OLMO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:787-944-5516
Mailing Address - Street 1:191 CHATEAU SAN JUAN
Mailing Address - Street 2:APART 1503
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:939-263-3462
Mailing Address - Fax:
Practice Address - Street 1:191 CHATEAU SAN JUAN
Practice Address - Street 2:APART 1503
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:939-263-3462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty