Provider Demographics
NPI:1861653289
Name:VELLON, ALBA L (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ALBA
Middle Name:L
Last Name:VELLON
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 1:1926 CALLE DIEGO PENALOZA
Mailing Address - Street 2:FAIR VIEW
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7748
Mailing Address - Country:US
Mailing Address - Phone:787-475-3864
Mailing Address - Fax:
Practice Address - Street 1:690 CALLE GONZALO GALLEGOS
Practice Address - Street 2:FAIR VIEW
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7725
Practice Address - Country:US
Practice Address - Phone:787-755-4771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR77091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical