Revive Holistic Psychology & Wellness Center

Primary specialty

PsychologistTaxonomy code 103T00000X

License

005152 Issued in PR

Legal business name

REVIVE HOLISTIC PSYCHOLOGY & WELLNESS CENTER

Practice address

169 Butare Ave #1
Plaza Real 207
Guaynabo, PR 00969

Phone

(787) 562-6500

NPI assigned

Jul 9, 2013

Organization subpart

No

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

Authorized official

Name

Carol Roldan, PSY.NPI 1043651953

Title

Psychologist

Phone

(787) 562-6500

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carol Roldan, PSY.

  • Psychologist
  • Guaynabo, PR
  • NPI 1043651953
  NPD (past) Authorized official

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

{
    "created_epoch": "1373328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377820800000",
    "number": "1700227618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 LA MANCHA MANS. CIUDAD JARDIN",
            "city": "CAUAS",
            "state": "PR",
            "postal_code": "007271430",
            "telephone_number": "787-562-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 BUTARE AVE #1",
            "address_2": "PLAZA REAL 207",
            "city": "GUAYNABO",
            "state": "PR",
            "postal_code": "00969",
            "telephone_number": "787-562-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE HOLISTIC PSYCHOLOGY & WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-09",
        "last_updated": "2013-08-30",
        "status": "A",
        "authorized_official_last_name": "ROLDAN",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "787-562-6500",
        "authorized_official_credential": "PSY."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "PR",
            "license": "005152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rocio L. Reteguis, D.M.D.
• Retina Associates CSP
• Retina Specialists of Puerto Rico, PSC
• Robert Reveron Feliciano, 1334P
• Mark Reveron Mayol
• Revive Quiropractica, LLC
• Luis M Reyes Baez
• Ramon Reyes Cordero, 0588P
• Lizaida Reyes Cortes, 1885P
• Benjamin Reyes Diaz, M.PSY

• Psychologist in Guaynabo, PR
• Providers in Guaynabo, PR by specialty
• Psychologist in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2013; 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.