Provider Demographics
NPI:1104210806
Name:LOPEZ, LILIBETH (LCDA)
Entity Type:Individual
Prefix:
First Name:LILIBETH
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 45 BOX 10246
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-9626
Mailing Address - Country:US
Mailing Address - Phone:939-389-5366
Mailing Address - Fax:
Practice Address - Street 1:CARR 14 KM 68.5
Practice Address - Street 2:HC 45 BOX 10246
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-9608
Practice Address - Country:US
Practice Address - Phone:939-389-5366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004133103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling