Provider Demographics
NPI:1477151017
Name:PACHECO LLANOS, YESENIA MERCEDES (LICENCIADA)
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:MERCEDES
Last Name:PACHECO LLANOS
Suffix:
Gender:F
Credentials:LICENCIADA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URBANIZACION BAYAMON GARDENS CALLE SANDY
Mailing Address - Street 2:HH30
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-628-4616
Mailing Address - Fax:
Practice Address - Street 1:1051 AVE MUNOZ RIVERA
Practice Address - Street 2:FL 13
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-2701
Practice Address - Country:US
Practice Address - Phone:787-628-4616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR153791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty