Provider Demographics
NPI:1306816822
Name:URENA PICHARDO, LOURDES B (PHD)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:B
Last Name:URENA PICHARDO
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 1:155 CALLE FLAMBOYAN
Mailing Address - Street 2:HAC. MI QUERIDO VIEJO
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-2616
Mailing Address - Country:US
Mailing Address - Phone:787-325-4850
Mailing Address - Fax:787-261-4145
Practice Address - Street 1:BOULEVARD AVE. CALLE CABAL #BB-64
Practice Address - Street 2:LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-261-4145
Practice Address - Fax:787-261-4145
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1827103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20482Medicare ID - Type Unspecified