Provider Demographics
NPI:1821658816
Name:CRESPO, DAIRA DEL MAR (CSW, MD)
Entity Type:Individual
Prefix:
First Name:DAIRA
Middle Name:DEL MAR
Last Name:CRESPO
Suffix:
Gender:F
Credentials:CSW, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 CALLE FLAMBOYAN
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-9803
Mailing Address - Country:US
Mailing Address - Phone:939-639-0402
Mailing Address - Fax:
Practice Address - Street 1:279 CARRETERA 693 BRENAS
Practice Address - Street 2:BO BRENAS
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:939-639-0402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR105291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty