Provider Demographics
NPI:1649598897
Name:LEBRON, ELISA M (MA)
Entity Type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:M
Last Name:LEBRON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CONDOMINIO CORDOBA PARK 400 APTDO. 112
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9773
Mailing Address - Country:US
Mailing Address - Phone:787-923-4542
Mailing Address - Fax:
Practice Address - Street 1:COND CORDOVA PARK
Practice Address - Street 2:400 BO. TORTUGO APT 112
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-9769
Practice Address - Country:US
Practice Address - Phone:787-923-4542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3575103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool