Healthcare Provider Details

I. General information

NPI: 1306816822
Provider Name (Legal Business Name): LOURDES B. URENA PICHARDO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOULEVARD AVE. CALLE CABAL #BB-64 LEVITTOWN
TOA BAJA PR
00949
US

IV. Provider business mailing address

155 CALLE FLAMBOYAN HAC. MI QUERIDO VIEJO
DORADO PR
00646-2616
US

V. Phone/Fax

Practice location:
  • Phone: 787-261-4145
  • Fax: 787-261-4145
Mailing address:
  • Phone: 787-325-4850
  • Fax: 787-261-4145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1827
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: