Provider Demographics
NPI:1750503256
Name:CASILLAS, NEITZA DARLENE (MSW)
Entity Type:Individual
Prefix:MISS
First Name:NEITZA
Middle Name:DARLENE
Last Name:CASILLAS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:NEITZA
Other - Middle Name:DARLENE
Other - Last Name:CASILLAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:VILLA CAROLINA CALLE 609
Mailing Address - Street 2:BLOQUE 231 CASA 5
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985
Mailing Address - Country:US
Mailing Address - Phone:787-752-5380
Mailing Address - Fax:787-763-7515
Practice Address - Street 1:CALLE 609 VILLA CAROLINA
Practice Address - Street 2:BLOQUE 231 CASA 5
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-752-5380
Practice Address - Fax:787-763-7515
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR146511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9568OtherCLINIC
PR9568OtherCLINIC