Provider Demographics
NPI:1326287277
Name:GARCIA, LILLIAN DAMARIS
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:DAMARIS
Last Name:GARCIA
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:HC 77 BOX 7798
Mailing Address - Street 2:BRENAS
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-9715
Mailing Address - Country:US
Mailing Address - Phone:787-449-5416
Mailing Address - Fax:
Practice Address - Street 1:HC 77 BOX 7798
Practice Address - Street 2:BRENAS
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-9715
Practice Address - Country:US
Practice Address - Phone:787-449-5416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3228103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist