Provider Demographics
NPI:1922440619
Name:PORTUONDO, GLADYS ODETTE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:ODETTE
Last Name:PORTUONDO
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:HC 1 BOX 6831
Mailing Address - Street 2:BO. MACANA C/378 KM 0.8 GUAYANILLA PR 00656
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-9496
Mailing Address - Country:US
Mailing Address - Phone:787-405-4357
Mailing Address - Fax:
Practice Address - Street 1:HC 01 BOX 6831
Practice Address - Street 2:
Practice Address - City:GUAYANILLA
Practice Address - State:PR
Practice Address - Zip Code:00656-9781
Practice Address - Country:US
Practice Address - Phone:787-405-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR116751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical