Provider Demographics
NPI:1639519994
Name:LASSALA, MARIA S
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:S
Last Name:LASSALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B35 CALLE SAN AGUSTIN
Mailing Address - Street 2:URB. LOS DOMINICOS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-5906
Mailing Address - Country:US
Mailing Address - Phone:787-318-5420
Mailing Address - Fax:
Practice Address - Street 1:B35 CALLE SAN AGUSTIN
Practice Address - Street 2:URB. LOS DOMINICOS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-5906
Practice Address - Country:US
Practice Address - Phone:787-318-5420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6106104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker