Provider Demographics
NPI:1144106154
Name:GARAY PAGAN, LEIDY MARIE
Entity type:Individual
Prefix:
First Name:LEIDY
Middle Name:MARIE
Last Name:GARAY PAGAN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 CALLE EIDER APT 307A
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-2353
Mailing Address - Country:US
Mailing Address - Phone:787-940-6102
Mailing Address - Fax:
Practice Address - Street 1:300 AVE LAUREL # 2A
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-3273
Practice Address - Country:US
Practice Address - Phone:787-400-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25-421500106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician