Provider Demographics
NPI:1396043220
Name:MARRERO, LUIS ALBERTO SR
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ALBERTO
Last Name:MARRERO
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:LUIS
Other - Middle Name:ALBERTO
Other - Last Name:MARRERO
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:MSW, MIOP
Mailing Address - Street 1:104 CALLE RUISENOR
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-7000
Mailing Address - Country:US
Mailing Address - Phone:787-358-7948
Mailing Address - Fax:
Practice Address - Street 1:1 CALLE DEL PARQUE
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-2151
Practice Address - Country:US
Practice Address - Phone:787-358-7948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR104281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical