Provider Demographics
NPI:1770019077
Name:AZUAJE, LISBETH (PHD)
Entity Type:Individual
Prefix:
First Name:LISBETH
Middle Name:
Last Name:AZUAJE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CALLE AUGUSTO RODRIGUEZ
Mailing Address - Street 2:URB. MONTICIELO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2515
Mailing Address - Country:US
Mailing Address - Phone:787-648-3744
Mailing Address - Fax:
Practice Address - Street 1:124 CALLE AUGUSTO RODRIGUEZ
Practice Address - Street 2:URB MONTICIELO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-648-3744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4073103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4781702OtherDRIVER LICENCE