Provider Demographics
NPI:1538692751
Name:CEPEDA, ANGELIZ (MSW)
Entity Type:Individual
Prefix:MISS
First Name:ANGELIZ
Middle Name:
Last Name:CEPEDA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE E 13 ER 21
Mailing Address - Street 2:URB. BRISAS DEL MAR
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773
Mailing Address - Country:US
Mailing Address - Phone:787-909-7431
Mailing Address - Fax:
Practice Address - Street 1:LOIZA VALLEY SHOPPING CENTER
Practice Address - Street 2:LOCAL AA-7
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00773
Practice Address - Country:US
Practice Address - Phone:787-256-0273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21160104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker