Nicelia Raquel Pena, PSYD
Individual provider Active NPI Clinical Psychologist · Lajas, PR
NPI 1457571085 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1457571085
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 2496 (PR)
- Practice address
- Flamboyan 237
Lajas, PR 00667 - Phone
- (787) 809-1835
- Fax
- (787) 899-5141
- NPI assigned
- Apr 26, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
770 Ave Hostos
Mayaguez, PR 00682-1551
Phone (787) 697-1110
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110331000496 | PR | Practitioner - Clinical Psychologist | 2163461120 |
Reassigns benefits to 1 organization Practice locations: Mayaguez, PR |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bella Vista Hospital, Inc | Clinical | Current |
Accepting new patients |
| Bella Vista Hospital, Inc | Current |
Accepting new patients | |
| Centro de Salud de Lares, Inc. | Past | Accepting new patients | |
| Rovico Healthcare Administrative and Consulting Services Inc | Past | Accepting new patients | |
| Rovico Health Care Administrative and Consulting Services Inc | Past | Accepting new patients |
Locations
770 Ave Hostos
Ste 302A
Mayaguez, PR 00682
Phone (787) 407-1490
770 Ave Hostos
Bldg 302A
Mayaguez, PR 00682
770 Ave Hostos
#M
Mayaguez, PR 00682
770 Ave Hostos
#B
Mayaguez, PR 00682
Phone (787) 697-1110
Interoperability endpoints
- nicelia.pena.p1@direct.vitacare.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2496 | PR | Yes |
Addresses
Primary practice location
Flamboyan 237
Lajas, PR 00667
Mailing address
So23 Calle Lima
Valle Hermoso
Hormigueros, PR 00660-1230
Phone (787) 452-3612
Other providers in Lajas, PR
- Veronica Ortiz Rodriguez
- Derek Israel Ortiz
- Omar Elyth Ortiz
- Paul'S Ophthalmics Corp
- Paula C Servicios Dentaes, CSP
- Josaida Luz Perez Motta
- Ramon Perez-Perez
- Elliot E Perez
- Pablo E Pons Damiani
- Psicomedica del Oeste CSP
All providers in Lajas, PR · Clinical Psychologist in Puerto Rico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.