Provider Demographics
NPI:1720118524
Name:LIZAMA, TRICIA ATOIGUE (MSW)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:ATOIGUE
Last Name:LIZAMA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:REFLECTION CENTER 222 CHALAN SANTO PAPA
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96910-5172
Mailing Address - Country:US
Mailing Address - Phone:671-477-5715
Mailing Address - Fax:671-477-5714
Practice Address - Street 1:222 CHALAN SANTO PAPA REFELCTION CENTER
Practice Address - Street 2:SUITE 102
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910-5172
Practice Address - Country:US
Practice Address - Phone:671-477-5715
Practice Address - Fax:671-472-6221
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU0000075106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUIMFT 0000075OtherPROFESSIONAL LICENSING