Provider Demographics
NPI:1427362029
Name:VILLALOBOS, SUSAN E (CLINICAL SOCIAL WORK)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:E
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
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 651
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638
Mailing Address - Country:US
Mailing Address - Phone:787-452-5386
Mailing Address - Fax:787-871-3919
Practice Address - Street 1:CARRETERA 146
Practice Address - Street 2:BARRIO COORDILLERA
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638
Practice Address - Country:US
Practice Address - Phone:787-452-5386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR99701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical