Provider Demographics
NPI:1235478280
Name:RESTO, MARTHA M (CSW)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:M
Last Name:RESTO
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND SEGOVIA
Mailing Address - Street 2:APT 1013
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3822
Mailing Address - Country:US
Mailing Address - Phone:787-955-1655
Mailing Address - Fax:
Practice Address - Street 1:AVE. GAUTIER BENITEZ
Practice Address - Street 2:ANEXO B-5
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-9809
Practice Address - Country:US
Practice Address - Phone:787-704-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR78871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical