Blvd Psychological Services P.S.C.

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

BLVD PSYCHOLOGICAL SERVICES P.S.C.

Practice address

3326 Paseo Carmen
Toa Baja, PR 00949-3136

Phone

(939) 399-3371

Fax

(939) 399-3372

NPI assigned

Feb 12, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brendaly Garcia Morales, PSY DNPI 1306395140

Title

Presidenta/Directora

Phone

(787) 462-1730

Specialties & licenses 7

Addresses

Other identifiers 1

Other names 1

• Clinic/Center - Multi-Specialty Other name

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brendaly Garcia Morales

  • Clinical Psychologist
  • Toa Baja, PR
  • NPI 1306395140
  Medicare reassignment NPD Authorized official
• Leslie Criado, PSYD, MSW

  • Clinical Psychologist
  • San Juan, PR
  • NPI 1487984530
  Medicare reassignment NPD
• Elizabeth Pena Payero, PSY.D

  • Clinical Psychologist
  • Toa Baja, PR
  • NPI 1275098410
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540166400000",
    "number": "1174023535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3326 PASEO CARMEN",
            "city": "TOA BAJA",
            "state": "PR",
            "postal_code": "009493136",
            "telephone_number": "939-399-3371",
            "fax_number": "939-399-3372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3326 PASEO CARMEN",
            "city": "TOA BAJA",
            "state": "PR",
            "postal_code": "009493136",
            "telephone_number": "939-399-3371",
            "fax_number": "939-399-3372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLVD PSYCHOLOGICAL SERVICES P.S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-12",
        "last_updated": "2018-10-22",
        "status": "A",
        "authorized_official_last_name": "GARCIA  MORALES",
        "authorized_official_first_name": "BRENDALY",
        "authorized_official_title_or_position": "PRESIDENTA/DIRECTORA",
        "authorized_official_telephone_number": "787-462-1730",
        "authorized_official_credential": "PSY D"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "PR",
            "license": null,
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Adult Development & Aging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "PR",
            "license": null,
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Health",
            "state": "PR",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "5672",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinic/Center - Multi-Specialty",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Ubaldo Bocanegra, M.D.
• Bodhi LLC
• Bianca Vanessa Bonafont
• Angelica Marie Bonilla Tanon, PSYD
• Boricua Ambulance, Inc.

• Multi-Specialty Clinic/Center in Toa Baja, PR
• Providers in Toa Baja, PR by specialty
• Multi-Specialty Clinic/Center in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2018; 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.

Verify at the official NPI Registry.