| Mente Activa | |
|
775 Calle Caoba Centro Comercial Los Caobos, Suite 10 Ponce PR 00716-2610 | |
| (787) 677-0503 | |
| Not Available |
| Full Name | Mente Activa |
|---|---|
| Speciality | Psychologist |
| Location | 775 Calle Caoba, Ponce, Puerto Rico |
| Authorized Official Name and Position | Jaisselle Marie Vega (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7876770503 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mente Activa 775 Calle Caoba Centro Comercial Los Caobos, Suite 10 Ponce PR 00716-2610 Ph: (787) 677-0503 | Mente Activa 775 Calle Caoba Centro Comercial Los Caobos, Suite 10 Ponce PR 00716-2610 Ph: (787) 677-0503 |
| NPI Number | 1023561230 |
|---|---|
| Provider Enumeration Date | 07/25/2016 |
| Last Update Date | 04/17/2021 |
| Certification Date | 04/17/2021 |
| Medicare PECOS PAC ID | 5092088583 |
|---|---|
| Medicare Enrollment ID | O20170905002421 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023561230 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TB0200X | Psychologist - Cognitive & Behavioral | (* (Not Available)) | Primary |
| 311500000X | Alzheimer Center (dementia Center) | (* (Not Available)) | Secondary |
| Provider Name | Jaisselle Marie Vega Rosaly |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1104379320 PECOS PAC ID: 3173896669 Enrollment ID: I20171215002309 |
| Provider Name | Jannette Marie Batista Claudio |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275089906 PECOS PAC ID: 0143588384 Enrollment ID: I20171218001583 |
| Provider Name | Joan Jazmin Torres Rodriguez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184275638 PECOS PAC ID: 3779906763 Enrollment ID: I20200709001493 |
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