Healthcare Provider Details

I. General information

NPI: 1033661954
Provider Name (Legal Business Name): JANITZA MARIN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO CEDRO CARR 185 KM 13.8
CAROLINA PR
00987
US

IV. Provider business mailing address

PO BOX 825
LAS PIEDRAS PR
00771-0825
US

V. Phone/Fax

Practice location:
  • Phone: 787-210-5274
  • Fax:
Mailing address:
  • Phone: 787-210-5274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11824
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: