Provider Demographics
NPI:1871780239
Name:LM BEHAVIORAL PSC
Entity type:Organization
Organization Name:LM BEHAVIORAL PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LILIANA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MIRANDA BROCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-272-1292
Mailing Address - Street 1:35 JC BORBON SUITE 67
Mailing Address - Street 2:PMB-383
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-272-1292
Mailing Address - Fax:
Practice Address - Street 1:GUAYNABO MEDICAL MALL
Practice Address - Street 2:140 AVE. LAS CUMBRES
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-272-1292
Practice Address - Fax:787-287-2487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16449261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health