Individual provider Active NPI

Mailene Marie Roman Tejera, PSYD

  • Clinical Psychologist
  • Camuy, PR
National Provider Identifier
1356086482
Registry record updated Jul 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
7260 Issued in PR
Practice address
Carr 119 KM 5.5 Interior, Bo. Puente
Camuy, PR 00627-0062
Phone
(787) 644-0743
NPI assigned
May 3, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 7260 PR Primary

Addresses

Primary practice location

Carr 119 KM 5.5 Interior, Bo. Puente
Camuy, PR 00627-0062

Mailing address

162 Calle Helio
Arecibo, PR 00612-8866
Phone (787) 644-0743

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230607000470 PR Practitioner - Clinical Psychologist 6406213404 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7260PRMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Mercado Roman Psychology Group PSC CurrentSince Mar 12, 2023 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1651536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688256000000",
    "number": "1356086482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "162 CALLE HELIO",
            "city": "ARECIBO",
            "state": "PR",
            "postal_code": "006128866",
            "telephone_number": "787-644-0743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARR 119 KM 5.5 INTERIOR, BO. PUENTE",
            "city": "CAMUY",
            "state": "PR",
            "postal_code": "006270062",
            "telephone_number": "787-644-0743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROMAN TEJERA",
        "first_name": "MAILENE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-03",
        "last_updated": "2023-07-02",
        "certification_date": "2023-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PR",
            "license": "7260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Camuy, PR

Sources for this page

Verify at the official NPI Registry.