Provider Demographics
NPI:1093173783
Name:RALAT, DANIELITH MAILIN (BSW)
Entity Type:Individual
Prefix:MISS
First Name:DANIELITH
Middle Name:MAILIN
Last Name:RALAT
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:MISS
Other - First Name:DANIELITH
Other - Middle Name:MAILIN
Other - Last Name:RALAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSW
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:J14 CALLE LIRIO VISTA ALEGRE
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:J14 CALLE LIRIO
Practice Address - Street 2:VISTA ALEGRE
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-943-6409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22914104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker