Healthcare Provider Details

I. General information

NPI: 1235313172
Provider Name (Legal Business Name): DRA. MARIBET LOPEZ FELICIANO, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA #2 INTERSECCION CALLE 1 PALENQUE
BARCELONETA PR
00617
US

IV. Provider business mailing address

CARRETERA #2 INTERSECCION CALLE 1 PALENQUE
BARCELONETA PR
00617
US

V. Phone/Fax

Practice location:
  • Phone: 787-485-3133
  • Fax:
Mailing address:
  • Phone: 787-485-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1908
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1992855050
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerNPI ENTITY TYPE-1

VIII. Authorized Official

Name: DR. MARIBET LOPEZ
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 787-485-3133