Individual provider Active NPI

Victor Enrique Emmanuelli Rodriguez II, PSYD

  • Counseling Psychologist
  • Trujillo Alto, PR
National Provider Identifier
1669108700
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
6206 Issued in PR
Practice address
Monte Atenas Office Park
Suite 205
Trujillo Alto, PR 00926-0000
Phone
(787) 310-5843
NPI assigned
Jul 30, 2022
Last updated
Nov 25, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X 6206 PR Primary

Addresses

Primary practice location

Monte Atenas Office Park
Suite 205
Trujillo Alto, PR 00926-0000

Mailing address

Encantada Rio Cristal
RC-30 Calle Via del Rio
Trujillo Alto, PR 00976-0000
Phone (787) 310-5843

Other practice location 1

386 Calle Manuel Domenech
San Juan, PR 00918-3719
Phone (787) 567-0070

Other identifiers 1

IdentifierTypeStateIssuer
039344701MedicaidPR

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

State licenses

LicenseStateTypeSpecialty
6206PRMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Psychology Castro Lebron PSC Clinical CurrentSince Aug 7, 2022 Accepting new patients
Alm Psychology Clinical Past Accepting new patients
Clinica Psicoalternativas PastSince Jul 19, 2020 Accepting new patients

Locations

166 Ave Barbosa
Catano, PR 00962
Phone (787) 788-4544

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1659139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1669108700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ENCANTADA RIO CRISTAL",
            "address_2": "RC-30 CALLE VIA DEL RIO",
            "city": "TRUJILLO ALTO",
            "state": "PR",
            "postal_code": "009760000",
            "telephone_number": "787-310-5843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MONTE ATENAS OFFICE PARK",
            "address_2": "SUITE 205",
            "city": "TRUJILLO ALTO",
            "state": "PR",
            "postal_code": "009260000",
            "telephone_number": "787-310-5843"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "386 Calle Manuel Domenech",
            "address_purpose": "LOCATION",
            "city": "San Juan",
            "state": "PR",
            "postal_code": "009183719",
            "country_code": "US",
            "telephone_number": "787-567-0070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EMMANUELLI RODRIGUEZ",
        "first_name": "VICTOR",
        "middle_name": "ENRIQUE",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-30",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "PR",
            "license": "6206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "039344701",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Trujillo Alto, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 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.

Verify at the official NPI Registry.