Provider Demographics
NPI:1295281939
Name:PRINCIPE PAGAN, KATIA YARITZA (MSW)
Entity type:Individual
Prefix:
First Name:KATIA
Middle Name:YARITZA
Last Name:PRINCIPE PAGAN
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 03 BOX 12455
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00987
Mailing Address - Country:UM
Mailing Address - Phone:787-685-0968
Mailing Address - Fax:
Practice Address - Street 1:CARR 856 KM 1 9 CAROLINA
Practice Address - Street 2:BO BARRAZAS 3 SECTOR NEGRO PAGAN
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-685-0968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR132041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical