Provider Demographics
NPI:1437633187
Name:NEGRON, LIZAMARIE (MASTER IN EDUCATION)
Entity Type:Individual
Prefix:MISS
First Name:LIZAMARIE
Middle Name:
Last Name:NEGRON
Suffix:
Gender:F
Credentials:MASTER IN EDUCATION
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 1633
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-1633
Mailing Address - Country:US
Mailing Address - Phone:939-277-9694
Mailing Address - Fax:
Practice Address - Street 1:57 CALLE DR CUETO
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-2887
Practice Address - Country:US
Practice Address - Phone:939-277-9694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003334103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist