Healthcare Provider Details

I. General information

NPI: 1184066276
Provider Name (Legal Business Name): TRANSFORMACION FAMILIAR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CALLE DEL CARMEN W FAJARDO PUEBLO
FAJARDO PR
00738-4718
US

IV. Provider business mailing address

9 CALLE DEL CARMEN W FAJARDO PUEBLO
FAJARDO PR
00738-4718
US

V. Phone/Fax

Practice location:
  • Phone: 787-801-0217
  • Fax: 787-801-0217
Mailing address:
  • Phone: 787-801-0217
  • Fax: 787-801-0217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number764
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14477
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8699
License Number StatePR

VIII. Authorized Official

Name: MRS. VILMARIES RODRIGUEZ
Title or Position: PRESIDEN
Credential:
Phone: 787-801-0217