Provider Demographics
NPI:1669515912
Name:GODREAU, LIANA C (PSYD)
Entity type:Individual
Prefix:DR
First Name:LIANA
Middle Name:C
Last Name:GODREAU
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Gender:F
Credentials:PSYD
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Mailing Address - Street 1:2004 GUADALYQUIVIR ST
Mailing Address - Street 2:URB RIO CANAS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-1825
Mailing Address - Country:US
Mailing Address - Phone:787-598-0727
Mailing Address - Fax:787-259-1560
Practice Address - Street 1:1326 SALUD ST
Practice Address - Street 2:EDIFICIO EL SENORIAL SUITE 415
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1689
Practice Address - Country:US
Practice Address - Phone:787-259-1560
Practice Address - Fax:787-259-1560
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR2065103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1826OtherHUMANA
PR219107OtherPREFERRED HEALTH