Healthcare Provider Details

I. General information

NPI: 1225905169
Provider Name (Legal Business Name): MONALIZA GROSS MARTINEZ-LOUZADA LPES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ILDERTON ST
SUMMERVILLE SC
29483-8194
US

IV. Provider business mailing address

101 ILDERTON ST
SUMMERVILLE SC
29483-8194
US

V. Phone/Fax

Practice location:
  • Phone: 203-673-9887
  • Fax:
Mailing address:
  • Phone: 203-673-9887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4856
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: