Provider Demographics
NPI:1770746273
Name:MELENDEZ, EVELYN (SW)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PUNTA LAS MARIA RA33 MARINA BAHIA
Mailing Address - Street 2:
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00962-0000
Mailing Address - Country:US
Mailing Address - Phone:787-388-9640
Mailing Address - Fax:
Practice Address - Street 1:URB. MARINA BAHIA RA 33 STREET PUNTA LAS MARIA
Practice Address - Street 2:
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-0000
Practice Address - Country:US
Practice Address - Phone:787-388-9640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9014104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker