Healthcare Provider Details

I. General information

NPI: 1982906335
Provider Name (Legal Business Name): ELENA ESPADA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 CALLE BUENOS AIRES
SAN JUAN PR
00915-4620
US

IV. Provider business mailing address

708 CALLE BUENOS AIRES
SAN JUAN PR
00915-4620
US

V. Phone/Fax

Practice location:
  • Phone: 787-393-0205
  • Fax:
Mailing address:
  • Phone: 787-393-0205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9486
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: