Provider Demographics
NPI:1760089205
Name:BORDADO MAY, KASSANDRA MARIE (LPRC)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:MARIE
Last Name:BORDADO MAY
Suffix:
Gender:F
Credentials:LPRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2501
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-2501
Mailing Address - Country:US
Mailing Address - Phone:787-346-7450
Mailing Address - Fax:
Practice Address - Street 1:#1542, CALLE BORI URB. BELISA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-274-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1609101YA0400X, 101YM0800X, 225C00000X
PR23237104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker