Provider Demographics
NPI:1851102008
Name:CLINICA PSICOLOGICA METANOIA LLC
Entity type:Organization
Organization Name:CLINICA PSICOLOGICA METANOIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCADO MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-458-5095
Mailing Address - Street 1:HC 3 BOX 25718
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-9353
Mailing Address - Country:US
Mailing Address - Phone:787-458-5095
Mailing Address - Fax:
Practice Address - Street 1:SAN GERMAN MEDICAL PLAZA
Practice Address - Street 2:201 CARR #2 KM 174
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-458-5095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)