Provider Demographics
NPI:1932778503
Name:LEBRON MATIAS, ATALIA MASSIEL (CLINICAL SOCIAL WORK)
Entity Type:Individual
Prefix:
First Name:ATALIA
Middle Name:MASSIEL
Last Name:LEBRON MATIAS
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 VILLAS DE JERUSALEN
Mailing Address - Street 2:
Mailing Address - City:PATILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00723-2422
Mailing Address - Country:US
Mailing Address - Phone:682-375-6545
Mailing Address - Fax:
Practice Address - Street 1:BO. MAMEY
Practice Address - Street 2:CARR 757 KM 10.6
Practice Address - City:PATILLAS
Practice Address - State:PR
Practice Address - Zip Code:00723-2422
Practice Address - Country:US
Practice Address - Phone:682-375-6545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR155581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty