Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 13672 | PR |
Y | 1041C0700X | Clinical Social Worker | 44SC05583400 | NJ |
N | 1041S0200X | School Social Worker | 542498 | NJ |
NPI | 1003202987 |
---|---|
Provider Name | Dr. Irma Sandoval-Arocho |
First Address | Isabela, PR 00662 |
Second Address | Isabela, PR 00662 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2015 |
Last Update Date | 22/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12796553 | CAQH (01) | NJ |