Healthcare Provider Details

I. General information

NPI: 1366453979
Provider Name (Legal Business Name): LUISARDO CARMONA SOCIAL WORKER,MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

POPC1010PASEO DEL VETERANO
PONCE PR
00716-2001
US

IV. Provider business mailing address

URB. REXMANOR ST 7 F-13
GUAYAMA PR
00785
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-3030
  • Fax: 787-651-4306
Mailing address:
  • Phone: 787-812-3030
  • Fax: 787-651-4306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number#6245
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: