Provider Demographics
NPI:1215409651
Name:SOTO ROMAN, JESSICA (BA)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:SOTO ROMAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:SOTO ROMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2015 BLVD LUIS A FERRE STE 101
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0798
Mailing Address - Country:US
Mailing Address - Phone:787-842-8945
Mailing Address - Fax:
Practice Address - Street 1:2015 BLVD LUIS A FERRE STE 101
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0798
Practice Address - Country:US
Practice Address - Phone:787-842-8945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24042104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker