Provider Demographics
NPI:1003020769
Name:ANAYA, LURDES RODRIGUEZ
Entity Type:Individual
Prefix:
First Name:LURDES
Middle Name:RODRIGUEZ
Last Name:ANAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LURDES
Other - Middle Name:RODRIGUEZ
Other - Last Name:ANAYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:40 CALLE VARIANTE
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-4223
Mailing Address - Country:US
Mailing Address - Phone:787-892-4126
Mailing Address - Fax:
Practice Address - Street 1:ASSMCA
Practice Address - Street 2:CARR #2
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-833-0663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2085103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling