Provider Demographics
NPI:1447745484
Name:BISBAL VICENS, LAURA (PSYD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BISBAL VICENS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB BORINQUEN GARDENS
Mailing Address - Street 2:BB2 CALLE AZALEA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-204-6616
Mailing Address - Fax:
Practice Address - Street 1:1416 AVE PAZ GRANELA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4271
Practice Address - Country:US
Practice Address - Phone:787-462-9860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6024103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical