Provider Demographics
NPI:1780390831
Name:DEMORIZI GUZMAN, LESHMARIE
Entity type:Individual
Prefix:MRS
First Name:LESHMARIE
Middle Name:
Last Name:DEMORIZI GUZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LOS COLOBOS PARK CALLE ALMENDRO 104
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:939-241-8777
Mailing Address - Fax:
Practice Address - Street 1:#463 AVE. JUAN PONCE DE LEON/PLAZA AEELA SUITE 712
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:939-205-2345
Practice Address - Fax:787-946-5549
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7527103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling