Provider Demographics
NPI:1497045801
Name:LOPEZ, BETSY (PSY D)
Entity Type:Individual
Prefix:DR
First Name:BETSY
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE POMARROSA CASA #221
Mailing Address - Street 2:URB. LOS SAUCES
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-508-0515
Mailing Address - Fax:
Practice Address - Street 1:CALLE POMARROSA CASA #221
Practice Address - Street 2:URB. LOS SAUCES
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-508-0515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3895103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical