Provider Demographics
NPI:1750644183
Name:WYS, LISBETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISBETH
Middle Name:
Last Name:WYS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:201 CALLE GAUTIER BENITEZ
Mailing Address - Street 2:CONSOLIDATED MEDICAL PLAZA SUITE 012, OFFICE 307 A
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-5527
Mailing Address - Country:US
Mailing Address - Phone:787-961-3600
Mailing Address - Fax:787-961-3601
Practice Address - Street 1:201 CALLE GAUTIER BENITEZ
Practice Address - Street 2:CONSOLIDATED MEDICAL PLAZA SUITE 012, OFFICE 307 A
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5527
Practice Address - Country:US
Practice Address - Phone:787-961-3600
Practice Address - Fax:787-961-3601
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4355103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical