Provider Demographics
NPI:1841601978
Name:LUGO, REY SR (LICENCIIADO)
Entity Type:Individual
Prefix:MISS
First Name:REY
Middle Name:
Last Name:LUGO
Suffix:SR
Gender:M
Credentials:LICENCIIADO
Other - Prefix:MISS
Other - First Name:VILMA
Other - Middle Name:
Other - Last Name:LUGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7908 CALLE DR. JOSE HENNA
Mailing Address - Street 2:URB. MARIAN
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0217
Mailing Address - Country:US
Mailing Address - Phone:787-396-2905
Mailing Address - Fax:787-844-2624
Practice Address - Street 1:7908 CALLE DR. JOSE HENNA
Practice Address - Street 2:URB. MARIANI
Practice Address - City:PONCE
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00717
Practice Address - Country:UM
Practice Address - Phone:787-396-2905
Practice Address - Fax:787-844-2624
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1046101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor