Provider Demographics
NPI:1013244003
Name:CRESPO, ANGEL LUIS (BSW)
Entity Type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:LUIS
Last Name:CRESPO
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE C NUMERO 74
Mailing Address - Street 2:URBANIZACION MENDEZ
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-3907
Mailing Address - Country:US
Mailing Address - Phone:787-995-5200
Mailing Address - Fax:787-740-4175
Practice Address - Street 1:CALLE C NUMERO 74
Practice Address - Street 2:URBANIZACION MENDEZ
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767-3907
Practice Address - Country:US
Practice Address - Phone:787-995-5200
Practice Address - Fax:787-740-4175
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17288104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker