Provider Demographics
NPI:1811663537
Name:ROSARIO SEPULVEDA, LUIS GUILLERMO (LCSW)
Entity type:Individual
Prefix:PROF
First Name:LUIS
Middle Name:GUILLERMO
Last Name:ROSARIO SEPULVEDA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 CALLE REINITA
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-5014
Mailing Address - Country:US
Mailing Address - Phone:787-601-5514
Mailing Address - Fax:
Practice Address - Street 1:3015 CALLE REINITA
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-5014
Practice Address - Country:US
Practice Address - Phone:787-601-5514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR157271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty