Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 6424 | PR |
NPI | 1003459736 |
---|---|
Provider Name | Marilyn Navedo-Rosado |
First Address | Bayamon, PR 00956-8248 |
Second Address | Bayamon, PR 00956-4820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2019 |
Last Update Date | 25/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6424 | SOCIAL WORK LICENSE (01) | PR |