Healthcare Provider Details

I. General information

NPI: 1326473315
Provider Name (Legal Business Name): MIRIAM CARTAGENA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE IRLANDA HTS # 17 SIRIO FM 17
BAYAMON PR
00956-5359
US

IV. Provider business mailing address

SIRIO FM17 URBANIZACION IRLANDA HEIGHTS
BAYAMON PR
00956
US

V. Phone/Fax

Practice location:
  • Phone: 939-717-3236
  • Fax:
Mailing address:
  • Phone: 939-717-3236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4804
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: