Jelisse Matos Renta, PSY.D
Individual provider Active NPI Clinical Psychologist · Ponce, PR
NPI 1720739899 · NPPES record last updated Aug 20, 2025
Key facts
- NPI
- 1720739899
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 6671 (PR)
- Practice address
- Calle Mayor
Ponce, PR 00730 - Phone
- (787) 905-5216
- NPI assigned
- Jan 11, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250807002653 | PR | Practitioner - Clinical Psychologist | 4284132408 |
Reassigns benefits to 1 organization Practice locations: Ponce, PR |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6671 | PR | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| N & N Psychological Services | Current |
Accepting new patients | |
| Mindwell Psychology Clinic | Clinical | Past |
Accepting new patients |
| Centro Holistico Bienestar Mental | Past |
Accepting new patients |
Locations
35 Calle Mayor
Ponce, PR 00730
Phone (787) 844-3077
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 6671 | PR | |
| School Psychologist | 103TS0200X | 6671 | PR | |
| Clinical Psychologist | 103TC0700X | 6671 | PR | Yes |
Addresses
Primary practice location
Calle Mayor
Ponce, PR 00730
Mailing address
202 Calle Principe
Coto Laurel, PR 00780-3211
Phone (787) 905-5216
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 131920 | Medicaid | PR |
Other names
- Dr. Jelisse Matos Renta
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | Patience | Health Information Exchange (HIE) |
Other providers in Ponce, PR
- Waldemar Matias
- Jorge R Matos Figueroa
- Gabriela N Matos Ortiz
- Eduardo Matos Postigo Sr.
- Stephanie Matos Quintana
- Jacob Christopher Matos-Castro
- Alexander Matos
- Barbara Matos
- Juan Edgardo Matos
- Marylin Matos
All providers in Ponce, PR · Clinical Psychologist in Puerto Rico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.