Provider Demographics
NPI:1205200912
Name:LARACUENTE, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LARACUENTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 CALLE GENIO
Mailing Address - Street 2:URB BALDORIOTY
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-2919
Mailing Address - Country:US
Mailing Address - Phone:787-210-1093
Mailing Address - Fax:
Practice Address - Street 1:3006 CALLE GENIO
Practice Address - Street 2:URB BALDORITY
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-2919
Practice Address - Country:US
Practice Address - Phone:787-210-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6182104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6182OtherSOCIAL WORKER