=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316328743
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIANGELIE MARRERO MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2015
-----------------------------------------------------
Last Update Date | 03/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR 981 KM 15.1 INT BO PUEBLO CENTRO DE SALUD INTEGRAL EN COROZAL
-----------------------------------------------------
City | COROZAL
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00783-9806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-859-2560
-----------------------------------------------------
Fax | 787-859-5390
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC6 BOX 13648
-----------------------------------------------------
City | COROZAL
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00783-9806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-219-1488
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 13303
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------