Provider Demographics
NPI:1164624466
Name:SANTANA-CHARRIEZ, LOURDES E (PSYD, MA)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:E
Last Name:SANTANA-CHARRIEZ
Suffix:
Gender:F
Credentials:PSYD, 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 288
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-0288
Mailing Address - Country:US
Mailing Address - Phone:787-360-4568
Mailing Address - Fax:
Practice Address - Street 1:27 CALLE NELSON PEREA
Practice Address - Street 2:EDIFICIO DOCTORS CENTER, SUITE 103
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-360-4568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1974103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling