Provider Demographics
NPI:1013413848
Name:OJEDA, LYANN (MS)
Entity Type:Individual
Prefix:
First Name:LYANN
Middle Name:
Last Name:OJEDA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 CALLE PARANA APT 2B
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2905
Mailing Address - Country:US
Mailing Address - Phone:787-244-5060
Mailing Address - Fax:
Practice Address - Street 1:1610 CALLE PARANA APT 2B
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2905
Practice Address - Country:US
Practice Address - Phone:787-244-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5964103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR512698659OtherPASSPORT