Provider Demographics
NPI:1740802362
Name:SEPULVEDA, CARLOS ALEXIS (MSW)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALEXIS
Last Name:SEPULVEDA
Suffix:
Gender:M
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:URB. FAIRVIEW CALLE 2
Mailing Address - Street 2:B 20
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-8140
Mailing Address - Country:US
Mailing Address - Phone:787-432-8268
Mailing Address - Fax:
Practice Address - Street 1:C-17 CALLE MARGINAL
Practice Address - Street 2:SANTA CRUZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-785-9381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR236251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical