Provider Demographics
NPI:1780908111
Name:LUCIANO, NILDA OMAYRA (MSW)
Entity type:Individual
Prefix:PROF
First Name:NILDA
Middle Name:OMAYRA
Last Name:LUCIANO
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:P.O. BOX 1882
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00623
Mailing Address - Country:UM
Mailing Address - Phone:787-216-9600
Mailing Address - Fax:787-851-6558
Practice Address - Street 1:445 GONZALEZ CLEMENTE
Practice Address - Street 2:SUITE 104
Practice Address - City:MAYAGUEZ
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00680
Practice Address - Country:UM
Practice Address - Phone:787-216-9600
Practice Address - Fax:787-851-6558
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-14
Last Update Date:2010-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR98801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical