Provider Demographics
NPI:1831404912
Name:ADMINISTRACION DE SERVICIOS DE SALUD MENTAL Y CONTRA LA ADICCION
Entity type:Organization
Organization Name:ADMINISTRACION DE SERVICIOS DE SALUD MENTAL Y CONTRA LA ADICCION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TRABAJADOR SOCIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:MARRERO
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-398-3528
Mailing Address - Street 1:PO BOX 607087
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-7087
Mailing Address - Country:US
Mailing Address - Phone:787-309-9736
Mailing Address - Fax:
Practice Address - Street 1:CARR. #2 KM. 8.2 BO. JUAN SANCHEZ
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-763-7575
Practice Address - Fax:787-995-5163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2575834251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management