Healthcare Provider Details

I. General information

NPI: 1518734813
Provider Name (Legal Business Name): LOYDA MARTY LUGO LPC, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 CALLE OLMO APT 410
SAN JUAN PR
00924-5503
US

IV. Provider business mailing address

501 CALLE OLMO APT 410
SAN JUAN PR
00924-5503
US

V. Phone/Fax

Practice location:
  • Phone: 787-518-6741
  • Fax:
Mailing address:
  • Phone: 787-679-3275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4387
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13746
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: