Provider Demographics
NPI:1083334189
Name:RIOS, LYDIA ISABEL (PHD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ISABEL
Last Name:RIOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3623 AVE MILITAR
Mailing Address - Street 2:SUITE 101 PMB 461
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662
Mailing Address - Country:US
Mailing Address - Phone:787-341-0143
Mailing Address - Fax:
Practice Address - Street 1:AVE. AGUSTIN RAMOS CALERO #7342 CAR. 112 KM 2.3
Practice Address - Street 2:BARRIO GUERRERO
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-341-0143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR007424103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical