Provider Demographics
NPI:1952807596
Name:LUGO RIVERA, PATRICIA CORAL (MA)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:CORAL
Last Name:LUGO RIVERA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1467
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-1467
Mailing Address - Country:US
Mailing Address - Phone:787-644-7176
Mailing Address - Fax:
Practice Address - Street 1:7 CALLE BALDORIOTY E
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-4902
Practice Address - Country:US
Practice Address - Phone:787-644-7176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5946103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5946OtherPSYCHOLOGIST LICENSE