Provider Demographics
NPI:1598227944
Name:PONS, MARVIN (LCSW/COUNSELOR)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:
Last Name:PONS
Suffix:
Gender:M
Credentials:LCSW/COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CALLE LUCHETTI
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-1609
Mailing Address - Country:US
Mailing Address - Phone:939-255-3165
Mailing Address - Fax:
Practice Address - Street 1:3 CALLE LUCHETTI
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-1609
Practice Address - Country:US
Practice Address - Phone:939-255-3165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR109521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical