Provider Demographics
NPI:1235608092
Name:ROMAN MORA, KEYLA MISHELLE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KEYLA
Middle Name:MISHELLE
Last Name:ROMAN MORA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0150
Mailing Address - Country:US
Mailing Address - Phone:787-556-4834
Mailing Address - Fax:
Practice Address - Street 1:CALLE RAFAEL CORDERO, ESQUINA TROCHE
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-745-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR138571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical