Provider Demographics
NPI:1376774067
Name:PADILLA, DENNISSE IVONNE (TRABAJADORA SOCIAL)
Entity Type:Individual
Prefix:MS
First Name:DENNISSE
Middle Name:IVONNE
Last Name:PADILLA
Suffix:
Gender:F
Credentials:TRABAJADORA SOCIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CALLE COLON
Mailing Address - Street 2:CLAUSELLS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-2040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 CALLE COLON
Practice Address - Street 2:CLAUSELLS
Practice Address - City:PONCE
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00730
Practice Address - Country:VG
Practice Address - Phone:787-841-7804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR104100000X104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker