Provider Demographics
NPI:1659515179
Name:ALONSO, IVELISSE (MSW)
Entity Type:Individual
Prefix:
First Name:IVELISSE
Middle Name:
Last Name:ALONSO
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:F23 CALLE HUCAR
Mailing Address - Street 2:COLINAS DE GUAYNABO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-6212
Mailing Address - Country:US
Mailing Address - Phone:787-923-0006
Mailing Address - Fax:
Practice Address - Street 1:F23 CALLE HUCAR
Practice Address - Street 2:COLINAS DE GUAYNABO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-6212
Practice Address - Country:US
Practice Address - Phone:787-923-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7019104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker