Provider Demographics
NPI:1861203382
Name:MINDBLOOM PSYCHOLOGICAL CENTER, LLC.
Entity type:Organization
Organization Name:MINDBLOOM PSYCHOLOGICAL CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-595-6085
Mailing Address - Street 1:2T-50 CALLE 30
Mailing Address - Street 2:MIRADOR DE BAIROA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-1002
Mailing Address - Country:US
Mailing Address - Phone:787-595-6085
Mailing Address - Fax:
Practice Address - Street 1:305 QUADRANGEL MEDICAL BUILDING
Practice Address - Street 2:AVE LUIS MUNOZ MARIN
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-595-6085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty