Provider Demographics
NPI:1679461248
Name:BAEZ, LYRIS (PSYD)
Entity type:Individual
Prefix:
First Name:LYRIS
Middle Name:
Last Name:BAEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LAS CAMPINAS 3 CALLE CIPRES
Mailing Address - Street 2:U7 LAS PIEDRAS
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-7201
Mailing Address - Country:US
Mailing Address - Phone:787-315-5837
Mailing Address - Fax:
Practice Address - Street 1:LS INNOVATIVE EDUCATION CENTER INC. HUMACAO
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-705-0893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6734103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR02241900OtherDEPARTAMENTO DE EDUCACION ESPECIAL