Healthcare Provider Details

I. General information

NPI: 1356261648
Provider Name (Legal Business Name): LISSETTE CRESPO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 7 H41 URBANIZACION TOA ALTA HEIGHTS
TOA ALTA PR
00953
US

IV. Provider business mailing address

CALLE 7 H41 URBANIZACION TOA ALTA HEIGHTS
TOA ALTA PR
00953
US

V. Phone/Fax

Practice location:
  • Phone: 939-389-9225
  • Fax:
Mailing address:
  • Phone: 939-389-9225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11419
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: