Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 9149 | PR |
NPI | 1003252131 |
---|---|
Provider Name | Belitza Lugo |
First Address | Coamo, PR 00769-2227 |
Second Address | Coamo, PR 00769-2227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2013 |
Last Update Date | 17/06/2013 |