Provider Demographics
NPI:1023752540
Name:DE JESUS, YARELIS (MSW)
Entity type:Individual
Prefix:MRS
First Name:YARELIS
Middle Name:
Last Name:DE JESUS
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:Q12 CALLE 18
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2048
Mailing Address - Country:US
Mailing Address - Phone:939-588-9645
Mailing Address - Fax:
Practice Address - Street 1:Q12 CALLE 18
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2048
Practice Address - Country:US
Practice Address - Phone:939-588-9645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR158951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty