Healthcare Provider Details

I. General information

NPI: 1255252623
Provider Name (Legal Business Name): LYMARIS RODRIGUEZ FELICIANO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 AVE. JOSE GAUTIER BENITEZ
CAGUAS PR
00725-0000
US

IV. Provider business mailing address

PO BOX 726
SAN LORENZO PR
00754-0726
US

V. Phone/Fax

Practice location:
  • Phone: 787-296-9776
  • Fax:
Mailing address:
  • Phone: 787-249-1596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1922
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: