=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053703140
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SOPHIA PINEIRO MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2015
-----------------------------------------------------
Last Update Date | 02/26/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 65 ITURREGUI PLAZA INFANTERIA SUITE 217-A
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-701-2626
-----------------------------------------------------
Fax | 787-768-8094
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1432 BARRACUDA ST BAHIA VISTAMAR
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00983-1452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-701-2626
-----------------------------------------------------
Fax | 787-768-8094
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 12920
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------