Healthcare Provider Details

I. General information

NPI: 1932064953
Provider Name (Legal Business Name): JACOB ABDEEL MARRERO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 CALLE CRUZ MARIA
MAYAGUEZ PR
00682-7571
US

IV. Provider business mailing address

566 CALLE CRUZ MARIA
MAYAGUEZ PR
00682-7571
US

V. Phone/Fax

Practice location:
  • Phone: 787-519-8902
  • Fax:
Mailing address:
  • Phone: 787-519-8902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16882
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: