Provider Demographics
NPI:1851101935
Name:ISLAND THERAPY COLLECTIVE LLC
Entity type:Organization
Organization Name:ISLAND THERAPY COLLECTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL RESIDENT AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBLEDO RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-432-9085
Mailing Address - Street 1:231 CALLE AMAPOLA
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-9011
Mailing Address - Country:US
Mailing Address - Phone:787-432-8085
Mailing Address - Fax:
Practice Address - Street 1:231 CALLE AMAPOLA
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-9011
Practice Address - Country:US
Practice Address - Phone:787-432-8085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-10
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty