Provider Demographics
NPI:1669016242
Name:JIRAU, JANNINA A (MSW)
Entity Type:Individual
Prefix:
First Name:JANNINA
Middle Name:A
Last Name:JIRAU
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 1:7365 URB MONTEBELLO
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-9764
Mailing Address - Country:US
Mailing Address - Phone:787-246-9920
Mailing Address - Fax:
Practice Address - Street 1:7365 URB MONTEBELLO
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-9764
Practice Address - Country:US
Practice Address - Phone:787-246-9920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR131701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty