Provider Demographics
NPI:1760508717
Name:BUSO, MARIA DE LOURDES (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:DE LOURDES
Last Name:BUSO
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:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0492
Mailing Address - Country:US
Mailing Address - Phone:787-312-8051
Mailing Address - Fax:
Practice Address - Street 1:19 CALLE DUFRESNE E
Practice Address - Street 2:SUITE 1
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3605
Practice Address - Country:US
Practice Address - Phone:787-312-8051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9013104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker