Healthcare Provider Details

I. General information

NPI: 1760390355
Provider Name (Legal Business Name): LYDMARY AYALA LA TORRE PSY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE PADRE RIVERA 15 OESTE SEGUNDO PISO
HUMACAO PR
00791-3691
US

IV. Provider business mailing address

CALLE AMATISTA 30 URB VILLA BLANCA
CAGUAS PR
00725-1904
US

V. Phone/Fax

Practice location:
  • Phone: 787-529-1559
  • Fax:
Mailing address:
  • Phone: 787-232-3011
  • Fax: 787-529-1559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6967
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: