Healthcare Provider Details

I. General information

NPI: 1619985421
Provider Name (Legal Business Name): LYNETTE D. MAESTRE-BONET MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 PASEO DEL VETERANO POPC
PONCE PR
00716-2001
US

IV. Provider business mailing address

1010 PASEO DEL VETERA URBANIZACION VILLA DEL CAPITAN #9
MAYAGUEZ PR
00682
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-3030
  • Fax:
Mailing address:
  • Phone: 787-833-7473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6600
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: