Provider Demographics
NPI:1225809767
Name:BERGOLLO, MARIBELLA (SOCIAL WORK 10402)
Entity Type:Individual
Prefix:
First Name:MARIBELLA
Middle Name:
Last Name:BERGOLLO
Suffix:
Gender:F
Credentials:SOCIAL WORK 10402
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 AVE RAMON RIOS
Mailing Address - Street 2:SABANA SECA
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00952
Mailing Address - Country:US
Mailing Address - Phone:787-949-5559
Mailing Address - Fax:
Practice Address - Street 1:5017 AVE RAMON RIOS
Practice Address - Street 2:SABANA SECA
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00952
Practice Address - Country:US
Practice Address - Phone:787-949-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10402104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker