Provider Demographics
NPI:1457758468
Name:PABON, MIRTA (MSW)
Entity type:Individual
Prefix:MRS
First Name:MIRTA
Middle Name:
Last Name:PABON
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:C10 CALLE 5
Mailing Address - Street 2:URBANIZACION VALLE ALTO
Mailing Address - City:PATILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00723-2200
Mailing Address - Country:US
Mailing Address - Phone:787-839-4118
Mailing Address - Fax:
Practice Address - Street 1:C10 CALLE 5
Practice Address - Street 2:URBANIZACION VALLE ALTO
Practice Address - City:PATILLAS
Practice Address - State:PR
Practice Address - Zip Code:00723-2200
Practice Address - Country:US
Practice Address - Phone:787-839-4118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR32351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical