Provider Demographics
NPI:1497096986
Name:LAUSELL, MARISA ZOE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARISA
Middle Name:ZOE
Last Name:LAUSELL
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:URB. RIO PIEDRAS HEIGHTS
Mailing Address - Street 2:CALLE URAL 1712
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-649-5359
Mailing Address - Fax:
Practice Address - Street 1:1689 CALLE PARANA, URB. RIO PIEDRAS HEIGHTS
Practice Address - Street 2:CALLE URAL 1712
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-649-5359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4575103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical