Provider Demographics
NPI:1609374347
Name:CARDONA, MELISSA (LCDA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CARDONA
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 7 BOX 75900
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-7322
Mailing Address - Country:US
Mailing Address - Phone:787-669-3454
Mailing Address - Fax:787-893-3947
Practice Address - Street 1:107 CALLE MAR BALTICO URB. BRISAS DEL MAR
Practice Address - Street 2:ISABELA
Practice Address - City:PR
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-669-3454
Practice Address - Fax:787-896-3947
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9809104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker