Provider Demographics
NPI:1083967905
Name:LIZARDI LOPEZ, MARIA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:M
Last Name:LIZARDI LOPEZ
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:PO BOX 1348
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-1348
Mailing Address - Country:US
Mailing Address - Phone:787-737-7636
Mailing Address - Fax:787-737-7636
Practice Address - Street 1:CALLE SANTIAGO NORTE
Practice Address - Street 2:#53 ALTOS
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-737-7636
Practice Address - Fax:787-737-7636
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical