Provider Demographics
NPI:1770954729
Name:DE JESUS CUBA, MARITZA (MSW)
Entity type:Individual
Prefix:MR
First Name:MARITZA
Middle Name:
Last Name:DE JESUS CUBA
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 1:121 AVE DR SUSONI
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-1843
Mailing Address - Country:US
Mailing Address - Phone:787-898-4190
Mailing Address - Fax:787-262-3984
Practice Address - Street 1:121 AVE DR SUSONI
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-1843
Practice Address - Country:US
Practice Address - Phone:787-898-4190
Practice Address - Fax:787-262-3984
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR86391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical