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General NPI Number Information
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NPI Number | 1417622101
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Entity Type | Individual
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Provider Name | LOURDENISSE PAGAN COLON MPSY
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Gender | Female
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Dates
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Enumeration Date | 08/13/2021
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 109 AVE JOSE DE DIEGO E
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City | CAYEY
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State | PR
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Zip | 00736-3822
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Country | US
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Telephone | 787-719-0610
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Fax |
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Provider Business Mailing Address
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Address Line | 20 SEC SAN JOSE
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City | CIDRA
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State | PR
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Zip | 00739-9402
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Country | US
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Telephone | 787-530-4689
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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 | 007043
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License Number State | PR
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