Provider Demographics
NPI:1376115949
Name:FLORES, JESSIE MARIE (MS W)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:MARIE
Last Name:FLORES
Suffix:
Gender:F
Credentials:MS W
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CALLE CEDRO
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-2053
Mailing Address - Country:US
Mailing Address - Phone:787-403-1725
Mailing Address - Fax:
Practice Address - Street 1:104 CALLE CEDRO
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-2053
Practice Address - Country:US
Practice Address - Phone:787-403-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
132811041C0700X
PR132811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty