Provider Demographics
NPI:1568073484
Name:BRACERO, LUZ MYRIAM (CPL)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:MYRIAM
Last Name:BRACERO
Suffix:
Gender:F
Credentials:CPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 71 BOX 16264
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9599
Mailing Address - Country:US
Mailing Address - Phone:787-349-6260
Mailing Address - Fax:
Practice Address - Street 1:CARR 174 KM 8.3
Practice Address - Street 2:BO GUARAGUAO ABAJO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-349-6260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4197101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional