Healthcare Provider Details

I. General information

NPI: 1639841943
Provider Name (Legal Business Name): LORNA LEBRON LEBRON II CLINICAL SOCIAL WORK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 10/05/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 3 KM 152.1 BARRIADA LOPEZ BARRIO AGUIRRE
SALINAS PR
00751
US

IV. Provider business mailing address

BARRIO CALZADA BUZON 141
MAUNABO PR
00707
US

V. Phone/Fax

Practice location:
  • Phone: 787-410-6076
  • Fax:
Mailing address:
  • Phone: 787-316-7992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15646
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier15646
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerCLINICAL SOCIAL WORKER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: