Provider Demographics
NPI:1336369610
Name:MEDINA-LAUREANO, LUCERY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LUCERY
Middle Name:
Last Name:MEDINA-LAUREANO
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:ROAD 155 CORNER ROAD. 643 KM 58.3
Mailing Address - Street 2:BO. PUGNADO
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-3549
Mailing Address - Country:US
Mailing Address - Phone:787-448-9374
Mailing Address - Fax:
Practice Address - Street 1:411 CALLE LISA
Practice Address - Street 2:SAN DEMETRIO
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-3549
Practice Address - Country:US
Practice Address - Phone:787-448-9374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1862103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent