Provider Demographics
NPI:1437874468
Name:ESTRADA, DENISSE LEILANIE
Entity Type:Individual
Prefix:
First Name:DENISSE
Middle Name:LEILANIE
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 65 BOX 6214
Mailing Address - Street 2:
Mailing Address - City:PATILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00723-9336
Mailing Address - Country:US
Mailing Address - Phone:787-475-0085
Mailing Address - Fax:
Practice Address - Street 1:BO. APEADERO SECTOR ESTRADA
Practice Address - Street 2:KM 3 HM 7 CARR 757
Practice Address - City:PATILLAS
Practice Address - State:PR
Practice Address - Zip Code:00723
Practice Address - Country:US
Practice Address - Phone:787-375-0085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR153521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical