Provider Demographics
NPI:1417622101
Name:PAGAN, LOURDENISSE (MPSY)
Entity Type:Individual
Prefix:
First Name:LOURDENISSE
Middle Name:
Last Name:PAGAN
Suffix:
Gender:F
Credentials:MPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SEC SAN JOSE
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-9402
Mailing Address - Country:US
Mailing Address - Phone:787-530-4689
Mailing Address - Fax:
Practice Address - Street 1:BARRIO CERTENEJAS SECTOR SAN JOSE STREET 172
Practice Address - Street 2:#20
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-530-4689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR007043103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling