=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396448395
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEISHLA ZOE BARRETO GARCIA MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2023
-----------------------------------------------------
Last Update Date | 04/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR 111
-----------------------------------------------------
City | AGUADILLA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-239-6146
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC 2 BOX 12238
-----------------------------------------------------
City | MOCA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00676-8203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-239-6146
-----------------------------------------------------
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 | 16397
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------