Healthcare Provider Details

I. General information

NPI: 1427362029
Provider Name (Legal Business Name): SUSAN E VILLALOBOS CLINICAL SOCIAL WORK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 146 BARRIO COORDILLERA
CIALES PR
00638
US

IV. Provider business mailing address

PO BOX 651
CIALES PR
00638
US

V. Phone/Fax

Practice location:
  • Phone: 787-452-5386
  • Fax:
Mailing address:
  • Phone: 787-452-5386
  • Fax: 787-871-3919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9970
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: