Provider Demographics
NPI:1881988574
Name:LUGO, LISSETTE (MSW)
Entity type:Individual
Prefix:MRS
First Name:LISSETTE
Middle Name:
Last Name:LUGO
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 1:860 CARR. 175 SENDEROS DEL RIO APTO. 1011
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-8244
Mailing Address - Country:US
Mailing Address - Phone:787-380-2288
Mailing Address - Fax:
Practice Address - Street 1:860 CARR 175 APT 1011
Practice Address - Street 2:SENDEROS DEL RIOS
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-380-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR107061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical