MEDICARE: LOYDA MARTY LUGO LPC, LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	13746	PR
2	101YM0800X	Mental Health Counselor	4387	PR

General Provider Information

NPI Number	:	1518734813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOYDA MARTY LUGO LPC, LSW

Provider Business Mailing Address
First Line	:	501 CALLE OLMO APT 410
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00924-5503
Country	:	US
Telephone Number	:	787-679-3275
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 CALLE OLMO APT 410
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00924-5503
Country	:	US
Telephone Number	:	787-518-6741
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2023
Last Update Date	:	12/06/2023

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