Healthcare Provider Details

I. General information

NPI: 1295413094
Provider Name (Legal Business Name): NICOLE MARIE REDONDO FIGUEROA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

F41 CALLE 17 URB BAYAMON GARDENS
BAYAMON PR
00957
US

IV. Provider business mailing address

F41 CALLE 17 URB BAYAMON GARDENS
BAYAMON PR
00957
US

V. Phone/Fax

Practice location:
  • Phone: 787-904-0716
  • Fax:
Mailing address:
  • Phone: 787-904-0716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15636
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: