Healthcare Provider Details

I. General information

NPI: 1124942503
Provider Name (Legal Business Name): EILEEN JEANNETTE CORREA - SERRANO CLINICAL SOCIAL WORK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 ESTANCIAS DE MEMBRILLO
CAMUY PR
00627
US

IV. Provider business mailing address

556 ESTANCIAS DE MEMBRILLO
CAMUY PR
00627
US

V. Phone/Fax

Practice location:
  • Phone: 939-295-2008
  • Fax:
Mailing address:
  • Phone: 939-295-2008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27327
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: