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General NPI Number Information
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NPI Number | 1649528084
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Entity Type | Organization
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Legal Business Name | CLINICAL SOCIAL WORKER
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 10 CALLE CASIA
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City | SAN JUAN
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State | PR
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Zip | 00921-3200
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Country | US
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Telephone | 787-248-4873
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 545
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City | FLORIDA
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State | PR
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Zip | 00650-0545
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Country | US
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Telephone | 787-248-4873
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | YANIRIS ORTIZ GONZALEZ
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Credential | LICENSE # 9309
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Telephone | 787-248-4873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 9309
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License Number State | PR
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