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General NPI Number Information
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NPI Number | 1104210806
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Entity Type | Individual
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Provider Name | LILIBETH LOPEZ LCDA
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Gender | Female
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Dates
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Enumeration Date | 03/20/2015
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Last Update Date | 03/20/2015
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Provider Practice Location Address
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Address Line | CARR 14 KM 68.5 HC 45 BOX 10246
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City | CAYEY
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State | PR
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Zip | 00736-9608
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Country | US
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Telephone | 939-389-5366
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Fax |
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Provider Business Mailing Address
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Address Line | HC 45 BOX 10246
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City | CAYEY
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State | PR
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Zip | 00736-9626
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Country | US
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Telephone | 939-389-5366
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 004133
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License Number State | PR
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