Active NPI
Jose Efrain Rodriguez Agosto, MA
- Clinical Psychologist
- Guaynabo, PR
National Provider Identifier
1114509536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6695
- Practice address
- 31 Calle 1
Urb. Montecielo
Guaynabo, PR 00970 - Phone
- (787) 307-9339
- NPI assigned
- Apr 26, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6695 | PR | Primary |
Addresses
Primary practice location
31 Calle 1
Urb. Montecielo
Guaynabo, PR 00970
Mailing address
PO Box 3327
Guaynabo, PR 00970-3327
Phone (787) 307-9339
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6695 | Other | PR | PSYCHOLOGIST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231206004179 | PR | Practitioner - Psychologist Billing Independently | 4587013214 | Practice locations: San Juan, PR |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619395200000",
"number": "1114509536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3327",
"city": "GUAYNABO",
"state": "PR",
"postal_code": "009703327",
"telephone_number": "787-307-9339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31 CALLE 1",
"address_2": "URB. MONTECIELO",
"city": "GUAYNABO",
"state": "PR",
"postal_code": "00970",
"telephone_number": "787-307-9339"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODRIGUEZ AGOSTO",
"first_name": "JOSE",
"middle_name": "EFRAIN",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-04-26",
"last_updated": "2021-04-26",
"certification_date": "2021-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PR",
"license": "6695",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGIST",
"identifier": "6695",
"state": "PR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Guaynabo, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.