Provider Demographics
NPI:1598818833
Name:LUCY LOPEZ ROIG Y ASOCIADOS
Entity Type:Organization
Organization Name:LUCY LOPEZ ROIG Y ASOCIADOS
Other - Org Name:LUCY LOPEZ ROIG & ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE VICEPRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:A
Authorized Official - Last Name:WENNERHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-763-6708
Mailing Address - Street 1:400 AVE DOMENECH
Mailing Address - Street 2:SUITE 701
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3710
Mailing Address - Country:US
Mailing Address - Phone:787-763-6708
Mailing Address - Fax:787-765-3650
Practice Address - Street 1:400 AVE DOMENECH
Practice Address - Street 2:SUITE 701
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3710
Practice Address - Country:US
Practice Address - Phone:787-763-6708
Practice Address - Fax:787-765-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR139103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty