=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932778503
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ATALIA M LEBRON MATIAS CLINICAL SOCIAL WORK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2021
-----------------------------------------------------
Last Update Date | 12/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | URB. VILLA ROSA I 350 CALLE 1
-----------------------------------------------------
City | GUAYAMA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00785-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-375-6545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 VILLAS DE JERUSALEN
-----------------------------------------------------
City | PATILLAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00723-2422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-375-6545
-----------------------------------------------------
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 | 15558
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------