Edwin Joel Medina Agosto, PSYCHOLOGIST

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

6508 Issued in PR

Practice address

29 Villa Encantada
Cidra, PR 00739-9563

Phone

(787) 212-9941

NPI assigned

Dec 31, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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.

• Psychological Empowerment LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Cidra, PR
  • NPI 1205420346
  NPD
• Grupo Medico Medicina Especializada

  • Clinic/Center
  • Cidra, PR
  • NPI 1700110178
  NPD (past)

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

{
    "created_epoch": "1577750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1609415272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 VILLA ENCANTADA",
            "city": "CIDRA",
            "state": "PR",
            "postal_code": "007399563",
            "telephone_number": "787-212-9941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 VILLA ENCANTADA",
            "city": "CIDRA",
            "state": "PR",
            "postal_code": "007399563",
            "telephone_number": "787-212-9941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA AGOSTO",
        "first_name": "EDWIN",
        "middle_name": "JOEL",
        "credential": "PSYCHOLOGIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-12-31",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "PR",
            "license": "6508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ada Martinez, RPH
• Guillermo F Martinez, M.D.
• Medical Family
• Medical Family Center
• Medical Family Center Corp.
• Grace M Medina, MSW
• Medwell Center, LLC
• Jose Enrique Melendez
• Yolyedmy Waleska Melendez, RPH
• Ruben Mendez Benabe, MD

• Counseling Psychologist in Cidra, PR
• Providers in Cidra, PR by specialty
• Counseling Psychologist in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.