Active NPI
Stephanie Ortiz-Domenech, PHD
- Clinical Psychologist
- San Juan, PR
National Provider Identifier
1497504856
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 7891
- Practice address
- 272 Planta Baja. Avenida Jesus T. Pinero
San Juan, PR 00918 - Phone
- (939) 866-0201
- NPI assigned
- May 16, 2024
- Last updated
- May 16, 2024
- Sex
- Female
- 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 | 7891 | PR | Primary |
Addresses
Primary practice location
272 Planta Baja. Avenida Jesus T. Pinero
San Juan, PR 00918
Mailing address
Calle 3 H24 Terrazas de Cupey
Trujillo Alto, PR 00976
Phone (787) 412-5117
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7891 | PR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715817600000",
"number": "1497504856",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "CALLE 3 H24 TERRAZAS DE CUPEY",
"city": "TRUJILLO ALTO",
"state": "PR",
"postal_code": "00976",
"telephone_number": "787-412-5117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "272 PLANTA BAJA. AVENIDA JESUS T. PINERO",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "00918",
"telephone_number": "939-866-0201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ORTIZ-DOMENECH",
"first_name": "STEPHANIE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-05-16",
"last_updated": "2024-05-16",
"certification_date": "2024-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PR",
"license": "7891",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Juan, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.