Provider Demographics
NPI:1225703812
Name:BERRIOS ORTIZ, LOURDES RAQUEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:RAQUEL
Last Name:BERRIOS ORTIZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 2725
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-9871
Mailing Address - Country:US
Mailing Address - Phone:787-342-0414
Mailing Address - Fax:
Practice Address - Street 1:PR-1 AVE. SAKURA BAIROA INDUSTRIAL PARK,
Practice Address - Street 2:OFICINA 235-A
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-705-5565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6739103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty