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General NPI Number Information
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NPI Number | 1700598570
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Entity Type | Individual
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Provider Name | ZAIMARY LICIAGA LOPEZ PSYD
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Gender | Female
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Dates
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Enumeration Date | 12/23/2022
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 167 CALLE SAN JUSTO
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City | QUEBRADILLAS
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State | PR
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Zip | 00678-1739
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Country | US
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Telephone | 939-585-2737
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Fax |
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Provider Business Mailing Address
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Address Line | 212 EXT LAMELA
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City | QUEBRADILLAS
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State | PR
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Zip | 00678-1722
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 7557
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License Number State | PR
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