Provider Demographics
NPI:1417829060
Name:PLAZA MENTAL HEALTH CLINIC LLC
Entity type:Organization
Organization Name:PLAZA MENTAL HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YAIRLEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PLAZA PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:939-295-8630
Mailing Address - Street 1:PMB 115 605 AVE TITO CASTRO NO 2431
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0000
Mailing Address - Country:US
Mailing Address - Phone:787-259-5555
Mailing Address - Fax:787-295-8630
Practice Address - Street 1:EDIFICIO PORRATA PILA 2431
Practice Address - Street 2:BLVD LUIS A FERRE SUITE 208
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2113
Practice Address - Country:US
Practice Address - Phone:787-259-5555
Practice Address - Fax:787-259-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty