Provider Demographics
NPI:1497900625
Name:LEON, CARLOS L (TS)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:L
Last Name:LEON
Suffix:
Gender:M
Credentials:TS
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 57
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-0057
Mailing Address - Country:US
Mailing Address - Phone:787-845-1188
Mailing Address - Fax:787-845-1188
Practice Address - Street 1:LUIS MUNOZ RIVERA 91 ST.
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757
Practice Address - Country:US
Practice Address - Phone:787-845-1188
Practice Address - Fax:787-845-1188
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker