MEDICARE: EDWIN BERNIE ALONSO OLMO MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	8336	PR
2	1041C0700X	Clinical Social Worker	14590	PR

General Provider Information

NPI Number	:	1841180213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN BERNIE ALONSO OLMO MA

Provider Business Mailing Address
First Line	:	65 AVE BARBOSA STE 103
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00612-2746
Country	:	US
Telephone Number	:	939-263-3462
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 AVE BARBOSA STE 103
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00612-2746
Country	:	US
Telephone Number	:	939-263-3462
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2025
Last Update Date	:	12/04/2025

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