Provider Demographics
NPI:1669897054
Name:SILVA, LYDIA J (PHD)
Entity type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:J
Last Name:SILVA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LYDIA
Other - Middle Name:J
Other - Last Name:SILVA-ROMERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1605 AVE PONCE DE LEON STE 610
Mailing Address - Street 2:EDIFICIO SAN MARTIN- SUITE 610
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-1824
Mailing Address - Country:US
Mailing Address - Phone:787-533-5577
Mailing Address - Fax:
Practice Address - Street 1:1605 AVE PONCE DE LEON
Practice Address - Street 2:EDIFICIO SAN MARTIN - SUITE 610
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1807
Practice Address - Country:US
Practice Address - Phone:787-533-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-22
Last Update Date:2014-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4048103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist