=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265395529
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SERVICIOS SOCIALES CLINICOS DE PR LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2025
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BO SANTA ROSA CARR 833
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00971-9579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-577-2137
-----------------------------------------------------
Fax | 939-577-2137
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC 5 BOX 7073
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00971-9579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-577-2137
-----------------------------------------------------
Fax | 939-577-2137
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | MAIRYN VARGAS
-----------------------------------------------------
Credential | MSW
-----------------------------------------------------
Telephone | 939-577-2137
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------