Psicodrama PR CP

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

14054 Issued in PR

Legal business name

PSICODRAMA PR CP

Practice address

Carr 2 KM 156.5
510 Ave Hostos Vista Verde Plaza Suite a-12a
Mayaguez, PR 00681

Phone

(788) 975-2710

NPI assigned

Feb 7, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Vannessa Pagan, MD

Title

President

Phone

(787) 400-5436

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1486425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486425600000",
    "number": "1700324092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 LAS CASONAS",
            "city": "AGUADA",
            "state": "PR",
            "postal_code": "006029221",
            "telephone_number": "787-975-2710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARR 2 KM 156.5",
            "address_2": "510 AVE HOSTOS VISTA VERDE PLAZA SUITE A-12A",
            "city": "MAYAGUEZ",
            "state": "PR",
            "postal_code": "00681",
            "telephone_number": "788-975-2710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSICODRAMA PR CP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-07",
        "last_updated": "2017-02-07",
        "status": "A",
        "authorized_official_last_name": "PAGAN",
        "authorized_official_first_name": "VANNESSA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "17874005436",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "PR",
            "license": "14054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Mayaguez, PR
• Providers in Mayaguez, PR by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2017; 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.