Provider Demographics
NPI:1104457449
Name:MENDEZ, LIZZETTE MARIE (PSY D)
Entity type:Individual
Prefix:DR
First Name:LIZZETTE
Middle Name:MARIE
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COND METROMONTE APT 149
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-7317
Mailing Address - Country:US
Mailing Address - Phone:939-218-6696
Mailing Address - Fax:
Practice Address - Street 1:CALLE RIVERA EDIF. PINEIRO 20
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:939-218-6699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6512103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical