Provider Demographics
NPI:1376781211
Name:DELIZ, LAURA M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:DELIZ
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:PO BOX 32267
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-2267
Mailing Address - Country:US
Mailing Address - Phone:787-812-1224
Mailing Address - Fax:
Practice Address - Street 1:CENTRO PONCENO DE AUTISMO
Practice Address - Street 2:CALLE SOL 120
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-2267
Practice Address - Country:US
Practice Address - Phone:787-812-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical