Healthcare Provider Details

I. General information

NPI: 1427303544
Provider Name (Legal Business Name): LUZ SELENIA CORREA-FILOMENO MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2012
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CALLE JORGE BIRD LEON W STE 103
FAJARDO PR
00738-5220
US

IV. Provider business mailing address

153 CALLE DIAMANTE
FAJARDO PR
00738-5080
US

V. Phone/Fax

Practice location:
  • Phone: 787-562-0910
  • Fax:
Mailing address:
  • Phone: 787-562-0910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4251
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: