Provider Demographics
NPI:1013890979
Name:MENTAL WELLNESS GROUP LLC
Entity type:Organization
Organization Name:MENTAL WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIVERA RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:787-201-4002
Mailing Address - Street 1:URB VILLA RICA AQ7
Mailing Address - Street 2:CALLE CENTRAL
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-201-4002
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO MEDICO HERMANAS DAVILAS OFICINA 208
Practice Address - Street 2:CALLE J ESQUINA B-16
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6057
Practice Address - Country:US
Practice Address - Phone:787-201-4002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty