Provider Demographics
NPI:1326899493
Name:LOPEZ CANCEL, BEVERLY CHARLEENE (PHD)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:CHARLEENE
Last Name:LOPEZ CANCEL
Suffix:
Gender:F
Credentials:PHD
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 477
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0477
Mailing Address - Country:US
Mailing Address - Phone:787-647-1266
Mailing Address - Fax:
Practice Address - Street 1:1735 CARR 844
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4446
Practice Address - Country:US
Practice Address - Phone:787-647-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR008178103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical