=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659630820
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORRECTIONAL ADMINISTRATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2012
-----------------------------------------------------
Last Update Date | 05/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CORRECCIONAL 384 SUITE #3
-----------------------------------------------------
City | SABANA HOYOS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00688
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-878-1170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC 2 BOX 4702
-----------------------------------------------------
City | SABANA HOYOS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00688
-----------------------------------------------------
Country | UM
-----------------------------------------------------
Telephone | 787-881-0979
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOCIAL WORKER
-----------------------------------------------------
Name | MRS. YANIRA SANTIAGO
-----------------------------------------------------
Credential | CMSW
-----------------------------------------------------
Telephone | 787-878-1170
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 10587
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------