Provider Demographics
NPI:1730539644
Name:THE BEHAVIORAL GROUP, PSC
Entity type:Organization
Organization Name:THE BEHAVIORAL GROUP, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIA VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-545-2718
Mailing Address - Street 1:130 AVE WINSTON CHURCHILL
Mailing Address - Street 2:PMB 359 SUITE 1
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6065
Mailing Address - Country:US
Mailing Address - Phone:787-545-2718
Mailing Address - Fax:787-545-2794
Practice Address - Street 1:COND MAGA
Practice Address - Street 2:BO MONACILLOS CENTRO MEDICO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1966
Practice Address - Country:US
Practice Address - Phone:787-545-2718
Practice Address - Fax:787-545-2794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13958207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR13958OtherLICENSE