1730539644 NPI number — THE BEHAVIORAL GROUP, PSC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730539644 NPI number — THE BEHAVIORAL GROUP, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE BEHAVIORAL GROUP, PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730539644
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 AVE WINSTON CHURCHILL
Provider Second Line Business Mailing Address:
PMB 359 SUITE 1
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-6065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-545-2718
Provider Business Mailing Address Fax Number:
787-545-2794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COND MAGA
Provider Second Line Business Practice Location Address:
BO MONACILLOS CENTRO MEDICO
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907-1966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-545-2718
Provider Business Practice Location Address Fax Number:
787-545-2794
Provider Enumeration Date:
06/21/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MEJIA VALLE
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-545-2718

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X , with the licence number:  13958 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 13958 . This is a "LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com