Provider Demographics
NPI:1558979427
Name:ZAYAS MARTINEZ, LUIS HIRAM (LIC, MCSW)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:HIRAM
Last Name:ZAYAS MARTINEZ
Suffix:
Gender:M
Credentials:LIC, MCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 CALLE SAN RAFAEL
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-1609
Mailing Address - Country:US
Mailing Address - Phone:787-238-8729
Mailing Address - Fax:
Practice Address - Street 1:CALLE 8 #373 EXT SAN AGUSTIN
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-238-8729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR157551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical