Healthcare Provider Details

I. General information

NPI: 1750503256
Provider Name (Legal Business Name): NEITZA DARLENE CASILLAS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NEITZA DARLENE CASILLAS MSW

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 609 VILLA CAROLINA BLOQUE 231 CASA 5
CAROLINA PR
00985
US

IV. Provider business mailing address

VILLA CAROLINA CALLE 609 BLOQUE 231 CASA 5
CAROLINA PR
00985
US

V. Phone/Fax

Practice location:
  • Phone: 787-752-5380
  • Fax: 787-763-7515
Mailing address:
  • Phone: 787-752-5380
  • Fax: 787-763-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14651
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: