Provider Demographics
NPI:1053631895
Name:LIZARDI, MARIA EUGENIA (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:EUGENIA
Last Name:LIZARDI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1773
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-1773
Mailing Address - Country:US
Mailing Address - Phone:787-854-7392
Mailing Address - Fax:
Practice Address - Street 1:ROD. 155 KM 58.5 BO. PUGNADO ADENTRO
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-642-0035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001718103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist