Provider Demographics
NPI:1457115263
Name:CASTRO- HERMIDA, DANA LIZ (LCDA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LIZ
Last Name:CASTRO- HERMIDA
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B3 URB SAN CRISTOBAL
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-2692
Mailing Address - Country:US
Mailing Address - Phone:787-929-0042
Mailing Address - Fax:
Practice Address - Street 1:CARR. 417 KM 0.5 BO PIEDRAS BLANCA DESVIO SUR
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-2692
Practice Address - Country:US
Practice Address - Phone:787-929-0042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7328103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty