Provider Demographics
NPI:1932240330
Name:BRAVO ORTIZ, LENNYS M (PH D)
Entity Type:Individual
Prefix:
First Name:LENNYS
Middle Name:M
Last Name:BRAVO ORTIZ
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CIUDAD JARDIN
Mailing Address - Street 2:82 CALLE GARDENIA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-2206
Mailing Address - Country:US
Mailing Address - Phone:787-710-1343
Mailing Address - Fax:787-710-1343
Practice Address - Street 1:132-13 AVE. ROBERTO CLEMENTE
Practice Address - Street 2:URB. VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-4124
Practice Address - Country:US
Practice Address - Phone:787-710-1343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1888103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist