Provider Demographics
NPI:1447016746
Name:ATYPICAL BRAINS, LLC
Entity type:Organization
Organization Name:ATYPICAL BRAINS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAHNIBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES MAYSONET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-636-7090
Mailing Address - Street 1:PO BOX 270178
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-0178
Mailing Address - Country:US
Mailing Address - Phone:939-399-3255
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER PLAZA NUM 2
Practice Address - Street 2:CALLE CASIA ESQ 3SE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:939-399-3255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-23
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty