Provider Demographics
NPI:1669131355
Name:AGUERRE DE SOSA, MARIA JOSE
Entity type:Individual
Prefix:
First Name:MARIA JOSE
Middle Name:
Last Name:AGUERRE DE SOSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 DUNLAWTON AVE APT 2712
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-7928
Mailing Address - Country:US
Mailing Address - Phone:954-404-2328
Mailing Address - Fax:
Practice Address - Street 1:1645 DUNLAWTON AVE APT 2712
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-7928
Practice Address - Country:US
Practice Address - Phone:954-404-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW166691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SW16669OtherLICENSED CLINICAL SOCIAL WORKER LICENSE