Provider Demographics
NPI:1881135861
Name:MELENDEZ, LIZA M (PHD)
Entity type:Individual
Prefix:DR
First Name:LIZA
Middle Name:M
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87-1 CALLE 70
Mailing Address - Street 2:URB SIERRA BAYAMON
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-4571
Mailing Address - Country:US
Mailing Address - Phone:787-675-6611
Mailing Address - Fax:
Practice Address - Street 1:A28 CALLE 1
Practice Address - Street 2:URB MAGNOLIA GARDENS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-2678
Practice Address - Country:US
Practice Address - Phone:787-675-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5692103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical