Provider Demographics
NPI:1679720882
Name:BRUNELL DEL VALLE, LISANDRA (PSY D)
Entity Type:Individual
Prefix:
First Name:LISANDRA
Middle Name:
Last Name:BRUNELL DEL VALLE
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 AVE DEGETAU # A-8
Mailing Address - Street 2:BONNEVILLE TERRACE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-5819
Mailing Address - Country:US
Mailing Address - Phone:787-258-5697
Mailing Address - Fax:
Practice Address - Street 1:AVE DEGETAU # A-8
Practice Address - Street 2:BONNEVILLE TERRACE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5819
Practice Address - Country:US
Practice Address - Phone:787-258-5697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3083103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical