Provider Demographics
NPI:1093007858
Name:VICENTY, EDUARDO (MSW)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:
Last Name:VICENTY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. CIUDAD PRIMAVERA CALLE BUENOS AIRES
Mailing Address - Street 2:E-1 BUZON 1401
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-8509
Mailing Address - Country:US
Mailing Address - Phone:787-219-9149
Mailing Address - Fax:
Practice Address - Street 1:URB. CIUDAD PRIMAVERA CALLE BUENOS AIRES
Practice Address - Street 2:E-1 BUZON 1401
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-8509
Practice Address - Country:US
Practice Address - Phone:787-219-9149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10725104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR$$$$$$$$$OtherSOCIAL SECURITY