# PSY CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Psy Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366930133
- **Authorized official:** DR. JACKELINE VELEZ MD (DIRECTOR)
- **Authorized official phone:** (787) 813-2222

## Contact information

- **Practice address:** LEGACY OFFICE PARK, SUITE 102, COTO LAUREL, PR 00780
- **Practice address phone:** (787) 813-2222
- **Practice address fax:** (787) 813-2222
- **Mailing address:** PO BOX 560, MERCEDITA, PR 00715-0560
- **Mailing address phone:** (787) 813-2222

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | PR | Yes |

## Other

- **Enumeration date:** 04/27/2018
- **Last updated:** 01/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1902055023 | — | PR |