Provider Demographics
NPI:1750763587
Name:RAMOS, JUAN JOSE SR (LCDP)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:JOSE
Last Name:RAMOS
Suffix:SR
Gender:M
Credentials:LCDP
Other - Prefix:MR
Other - First Name:JUAN
Other - Middle Name:JOSE
Other - Last Name:RAMOS
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:LCDP
Mailing Address - Street 1:P.O. BOX 25091
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-1233
Mailing Address - Country:US
Mailing Address - Phone:516-474-9906
Mailing Address - Fax:
Practice Address - Street 1:801 N WEST ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1525
Practice Address - Country:US
Practice Address - Phone:516-474-9906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECD-0000090101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid