Provider Demographics
NPI:1568914562
Name:PULICHINO LELONG, LIVIA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:LIVIA
Middle Name:A
Last Name:PULICHINO LELONG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A1 CALLE 6
Mailing Address - Street 2:URB. SANTA PAULA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-6616
Mailing Address - Country:US
Mailing Address - Phone:787-354-8071
Mailing Address - Fax:
Practice Address - Street 1:A1 CALLE 6
Practice Address - Street 2:URB SANTA PAULA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-354-8071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4926103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist