Provider Demographics
NPI:1013773159
Name:IRIZARRY, WANDA I (MS SOCIAL WORK)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:I
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:MS SOCIAL WORK
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 550
Mailing Address - Street 2:
Mailing Address - City:PUNTA SANTIAGO
Mailing Address - State:PR
Mailing Address - Zip Code:00741-0550
Mailing Address - Country:US
Mailing Address - Phone:787-319-1636
Mailing Address - Fax:
Practice Address - Street 1:URBANIZACION VILLAS DE CANDELERO
Practice Address - Street 2:CALLE GAVIOTA, A-1
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-319-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6539104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker