Provider Demographics
NPI:1376989020
Name:CLAVELL, MADELINE (SOCIAL WORKER)
Entity Type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:
Last Name:CLAVELL
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 AVE HOSTOS SUITE 7
Mailing Address - Street 2:CENTRO SALUD MENTAL MAYAGUEZ
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-1522
Mailing Address - Country:US
Mailing Address - Phone:787-833-3675
Mailing Address - Fax:787-833-1371
Practice Address - Street 1:410 AVE HOSTOS SUITE 7
Practice Address - Street 2:CENTRO SALUD MENTAL MAYAGUEZ
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1522
Practice Address - Country:US
Practice Address - Phone:787-833-3675
Practice Address - Fax:787-833-1371
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0323101YA0400X
PR196041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical