Healthcare Provider Details

I. General information

NPI: 1992855050
Provider Name (Legal Business Name): MARIBET LOPEZ PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
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

PO BOX 1966
BARCELONETA PR
00617-1966
US

V. Phone/Fax

Practice location:
  • Phone: 787-485-3133
  • Fax: 787-970-0781
Mailing address:
  • Phone: 787-485-3133
  • Fax: 787-970-0781

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:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: