Provider Demographics
NPI:1679203947
Name:NICOLAU, LIZEYLA ESTHER
Entity type:Individual
Prefix:
First Name:LIZEYLA
Middle Name:ESTHER
Last Name:NICOLAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 CALLE FALCON
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-9657
Mailing Address - Country:US
Mailing Address - Phone:787-206-5967
Mailing Address - Fax:
Practice Address - Street 1:10 VILLA TIRO
Practice Address - Street 2:716
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-206-5967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist