Healthcare Provider Details

I. General information

NPI: 1003202987
Provider Name (Legal Business Name): IRMA SANDOVAL-AROCHO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 CALLE HACIENDA LA REFORMA
ISABELA PR
00662
US

IV. Provider business mailing address

2030 CALLE HACIENDA LA REFORMA
ISABELA PR
00662
US

V. Phone/Fax

Practice location:
  • Phone: 609-647-2597
  • Fax:
Mailing address:
  • Phone: 609-647-2597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05583400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number542498
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13672
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier12796553
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerCAQH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: