Provider Demographics
NPI:1275652638
Name:BURGOS MARRERO, SYLVIA L (MSW ACSW)
Entity Type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:L
Last Name:BURGOS MARRERO
Suffix:
Gender:F
Credentials:MSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROAD 842 BUZON 47 ALTOMONTE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-640-1445
Mailing Address - Fax:
Practice Address - Street 1:ROAD #2 BAYAMON SHOPPING CENTER
Practice Address - Street 2:SUITE #10E MINI MALL
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-798-9097
Practice Address - Fax:787-740-2559
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1930104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR635OtherAPS HEALTHCARE
PR117019OtherFHCHS OF PR