Healthcare Provider Details

I. General information

NPI: 1467979518
Provider Name (Legal Business Name): JULERMARIE ORTA TELLADO CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8133 CALLE CONCORDIA STE 202
PONCE PR
00717-1543
US

IV. Provider business mailing address

1575 AVE MUNOZ RIVERA PMB 226
PONCE PR
00717-0211
US

V. Phone/Fax

Practice location:
  • Phone: 787-689-1020
  • Fax:
Mailing address:
  • Phone: 787-689-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14232
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: