Provider Demographics
NPI:1235679218
Name:OLIVERAS LORENZO, ANGELA MARIA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIA
Last Name:OLIVERAS LORENZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 CARR 2 APT 100
Mailing Address - Street 2:CONDOMINIO PRIMAVERA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-4843
Mailing Address - Country:US
Mailing Address - Phone:939-202-3497
Mailing Address - Fax:
Practice Address - Street 1:2340 CARR 2 APT 100
Practice Address - Street 2:CONDOMINIO PRIMAVERA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-4843
Practice Address - Country:US
Practice Address - Phone:939-202-3497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5511103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist