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General NPI Number Information
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NPI Number | 1235679531
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Entity Type | Individual
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Provider Name | LISSETTE NEGRON MARIN
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Gender | Female
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Dates
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Enumeration Date | 03/06/2017
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Last Update Date | 09/20/2019
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Provider Practice Location Address
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Address Line | EDIFICIO PORRATA PILA SUITE 208 BLVD. LUIS A FERRE 2431
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City | PONCE
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State | PR
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Zip | 00717
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Country | US
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Telephone | 787-404-1645
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Fax | 787-259-5555
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Provider Business Mailing Address
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Address Line | EDIF. PORRATA PILA SUITE 208 BLVD. LUIS A FERRE 2431
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City | PONCE
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State | PR
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Zip | 00717
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Country | US
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Telephone | 787-404-1645
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Fax | 787-259-5555
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 5840
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License Number State | PR
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