Healthcare Provider Details

I. General information

NPI: 1952047508
Provider Name (Legal Business Name): MELMARIE LUGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 05/06/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 AVE HOSTOS SUITE 7 CENTRO DE SALUD MENTAL MAYAGUEZ
MAYAGUEZ PR
00682
US

IV. Provider business mailing address

PO BOX 701
ENSENADA PR
00647-0701
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-0663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: