Healthcare Provider Details

I. General information

NPI: 1326899493
Provider Name (Legal Business Name): BEVERLY CHARLEENE LOPEZ CANCEL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PADRE RIVERA 15 OESTE
HUMACAO PR
00791
US

IV. Provider business mailing address

PO BOX 477
GURABO PR
00778-0477
US

V. Phone/Fax

Practice location:
  • Phone: 787-529-1559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number008178
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: