NPIMap

Organization Active NPI

Psidep LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Moca, PR
National Provider Identifier
1790414530
Registry record updated Jun 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
PSIDEP LLC
Practice address
Moca Medical Plaza #113 Carr 110 KM 12.4
Moca, PR 00676
Phone
(787) 546-7508
NPI assigned
Jun 7, 2022
Last updated
Jun 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2022

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

Authorized official

Name
Abdiel Muniz Vera, DRNPI 1376115295
Title
Director
Phone
(787) 546-7508

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

Moca Medical Plaza #113 Carr 110 KM 12.4
Moca, PR 00676

Mailing address

PO Box 1106
Moca, PR 00676-1106
Phone (787) 546-7508

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221010001471 PR Part B Supplier - Clinic/Group Practice 3173909488 Receives reassigned benefits from 2 practitioners
Practice locations: Moca, PR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1654560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654560000000",
    "number": "1790414530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1106",
            "city": "MOCA",
            "state": "PR",
            "postal_code": "006761106",
            "telephone_number": "787-546-7508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MOCA MEDICAL PLAZA #113 CARR 110 KM 12.4",
            "city": "MOCA",
            "state": "PR",
            "postal_code": "00676",
            "telephone_number": "787-546-7508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSIDEP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-07",
        "last_updated": "2022-06-07",
        "certification_date": "2022-06-01",
        "status": "A",
        "authorized_official_last_name": "MUNIZ VERA",
        "authorized_official_first_name": "ABDIEL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "787-546-7508",
        "authorized_official_credential": "DR"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moca, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.