Provider Demographics
NPI:1518734813
Name:MARTY LUGO, LOYDA (LPC, LSW)
Entity Type:Individual
Prefix:
First Name:LOYDA
Middle Name:
Last Name:MARTY LUGO
Suffix:
Gender:F
Credentials:LPC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CALLE OLMO APT 410
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-5503
Mailing Address - Country:US
Mailing Address - Phone:787-679-3275
Mailing Address - Fax:
Practice Address - Street 1:501 CALLE OLMO APT 410
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-5503
Practice Address - Country:US
Practice Address - Phone:787-518-6741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13746104100000X
PR4387101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker